443: Understanding Heart Rate Variability (HRV) and Why This Health Metric Matters with Dr. Molly Maloof

The point is to build capacity into the system so that when things are challenging, you do not break.

Welcome to Midlife Conversations. I'm your host, Natalie Jill, and I'm passionate about having amazing conversations that matter to us midlife women. On this podcast, I do what I do best, taking complicated health topics and breaking them down simply so that we can optimize aging. Together, I share actionable steps to help you thrive in what I believe are our best years to come. Join me as I interview the most inspiring people living their best midlife years and dive into essential topics like hormone changes, health optimization, weight management, blood sugar, emotional well being, relationships, beauty, and so much more. What exactly is hrv, and why should the average person care about it? And how accurate are all these HRV measurements on our fitness trackers and rings? And should we worry if it's consistently low or high? Or what if it jumps all over the place? And sometimes it's low and sometimes it's high. How much do we need to pay attention to this? And can we actually improve our hrv? And what are the most effective ways to do it? And could those tiny variations between these numbers, could they be an overlooked predictor of our longevity and our health and our stress levels? Today on Midlife Conversations, we're diving deep into one of the most misunderstood yet powerful biomarkers. With a renowned physician and health optimization expert, Dr. Molly Maloof. She'll decode the fascinating science of heart rate variability and why understanding the single measurement might transform your approach to health and wellness. Thank you so much for being here.

Thank you for having me.

So I want to dive right in. What exactly is hrv? I. I know it's heart rate variability, but what does that mean?

HRV is basically in a nutshell, the measure of time between heartbeats. So it's the beat to beat variation. So how quickly your heart rate returns to normal after it increases is a marker of resilience and adaptation. So when your heart rate is very high, there's not a lot of variation between heartbeats. So somebody who's chronically stressed and has a high heart rate Maybe has low VO2 max low cardiovascular health. A lot of people only lift weights and walk and they don't do any cardio because we've been kind of told, oh, chronic cardio is terrible. Well, that can actually lead to problems with your ability to be able to adapt to.

Demands like stress demands. So somebody who has a low heart rate and has a high hrv because they're usually inversely related, that low heart rate person has more space to adapt. So if they need to raise their heart rate to adapt to a stressor, they can do that. So as we get older, our blood vessels get stiffer, our heart gets weaker, and our HRV goes down. And so one of the goals of optimizing health is optimizing stress and our ability to adapt to stress. And that is a marker that is one of the major markers of health.

Okay, so when we see the term hrv, I just want to make sure I'm understanding this. It's the very. It's the actual variability between low and high. So if you have a low resting heart rate and you exercise or you're stressed and it goes up high, that variability, that number is showing the different the range. Right.

The B2B variation.

B2B variation.

So you want a healthy heart is able to adapt to demands and an unhealthy, or maybe just an aging person is less able to adapt. And this concept of homeostatic capacity is kind of a weird big word to say, but it's really your capacity to maintain homeostasis. And your body's job is to bring you back to baseline and to bring you back to normal after you've been dealt with a major stressor. As we get older, we became less. We become less resilient. So we get hit with stressors and they break us down. So the marker of a truly healthy person is not whether or not they get hit with a lot of stress here and there. It's actually how they adapting to that stress and are they actually being able to return back to baseline? And it's really hard in modern life to be able to be a highly adaptive person because there's so many things that are working against us. There's media, there's EMFs, there's toxins in the environment, there's sedentary lifestyles. I mean, we sit in front of the computers. A lot of us are knowledge workers and we have to work really hard to be able to work with our genes and our, our genetics and our primitive genetics, which is really designed to be totally opposite to what modern lives look like. So getting outside, getting sunlight, getting in, you know, having healthy circadian rhythms, having healthy, healthy sleep patterns are truly crucial to having an optimal hrv. But also not eating late at night. That's a big problem for a lot of people have. They eat late dinners and then they wake up with these terrible HRVs. They maybe drink at their dinner. One of the worst things you can do for your sleep is drinking.

Yeah.

So people having A glass of wine at like 9 o' clock at a late dinner with their friends. And it's like that actually is really, really bad for your sleep and for your hrv. And you know, this is the, this is the year where I'm like, you know what, I'm just kind of done with alcohol because it just isn't working for me anymore. It's not giving me any, any adaptation advantages. It's only worsening my health and it takes me a lot longer to recover from drinking. So I just decided this year I just am done now. I'm sure there's a lot of women listening that say they can't give up their glass of wine. They're like, there's no way you can take that from me. But the reality is it's like you need to ask yourself how long do you want to live and how do you want to feel? And I want to live a really long and healthy life and I want to feel fricking amazing and I want to wake up every morning and have the energy to take on my day. And I love sleep and I don't want to do anything that's going to impact my sleep. So sleep is a really first step, I would say to optimizing hiv. So many people have undiagnosed sleep apnea. Some people, so many people have problems with disordered breathing at night. Some people have restless legs at night. And like all of the sleep issues that you're dealing with are worsening your hrb. So I look at sleep as first and foremost. But if someone is having poor sleep, you also have to look at their daytime stress. So there are people that have zero. Like if you look in the OURA ring, one of the things that I like to show people is like if you look at your stress response, like where is your stress? What is your stress doing throughout the day? And if you see that your stress rate is like super high actually I can open up the oring and tell you exactly where to look. But it's like you really want to look at where is your stress throughout the day. So if you look at the readiness angle.

It will tell you like it will specifically. I mean I actually my rings not on today, but it will specifically tell you like how much recovery you're getting during the day and you're not recovering at all. Like I actually at one point in my life realized I wasn't having any recovery during the day and I would meditate in the morning and I would like do my wind down routine at night. But My full day was nonstop stress. So baking in not just fitness breaks, but also like, you know, just being able to sit and breathe and relax and meditate and calm your nervous system throughout the day. Most people aren't doing that. So we're in a chronic state of chronic threat. And, you know, then you're watching TV and watching the news and it's like putting you in a state of hyper vigilance.

Yes. So I'm going to ask. I want to have a lot more questions to go into with the sleep and stress, but I want to bring it back first to some really important things to make sure I'm, I'm. We're all clear here. So when you look at something like an OURA ring tracker, and it's just one of many trackers, first and foremost, is that number accurate on there?

Do you believe?

Do you think that's like an accurate number to go off?

If you really, truly want to get an accurate HRV assessment, you need to wear a chest strap.

A chest strap.

And I'm trying to remember the company that I heard about. I actually, I find it to be really difficult to use these straps, to be entirely honest with you. Morpheus is the brand that you want to look at because they're going to. You're going to use a chest strap and you're also going to get prescribed fitness recommendations. So there's a certain amount of specific types of cardio that they're going to recommend that you do in the app. And this is something that's really missing from a lot of people's conversations around, like optimizing HRV is you're missing A, the right measurement and B, you're missing the right.

Plan.

Okay.

So a lot of your HRV is directly tied to your cardiovascular health.

Makes sense. Okay. And a chest strap would be more accurate than chest strap.

Is measurement the most accurate. Okay. That being said, I do think that your individual HRV on your OURA ring is a decent monitor for recovery because it's measuring you at night and most of the time at night you're not moving around and it's got better. But I wouldn't, I wouldn't definitively say that if I have an HRV of 25, that that is my HRV. Like, I would say that that is your aura ring baseline. And that baseline could be used to optimize your health and your sleep and your fitness. Like, for example, if I went out, I went out till 4am to two weekends ago, my friend's 40th birthday, I didn't drink almost. I had one glass of, one glass that night. But I was just up with my friends, you know, having a good time, dancing. And that lack of sleep caused my HRV to plummet to 15. Okay, that is not a good HRV. Right. But I had a reason for it, right? Like, I went out till 4. I literally was up till the sun came up. And that was a massive disruption. Now I was going to go work out that day and I looked at my job and I said, if I go work out, I'm going to get injured. Because you do not want to work out on a day where your HRV is just garbage. But that hrv, is that my actual hrv? No, but that is my OURA ring. Ever. That is my, that is my aberration from my baseline in OURA ring. So I wouldn't look at OURA ring or whoop as like your definitive number because these are worn on your hands and your wrists, but they are a useful tool for tracking over time your baseline with that specific tool.

But the variations, what's important, if I'm hearing you correctly, it's the variation.

It's your own individual variation from your own individual baseline that those things can give you. Okay, but if you really want to be optimizing HRV in a concerted manner with actual evidence and real world research behind accuracy, you want to use a chest strap and you want.

That makes sense. Okay. So when we're looking at. So we want to use a chest strap for actual accuracy to know your true hrv. So that if I'm hearing, especially if.

You'Re trying to train yourself, like if you're trying to do training, for example, like if you want to do training to improve your hrv, you're going to want to train with a chest strap on. You're not going to use your aura ring as your training tool because you're like, for example, my ordering does not. It can do a decent job predicting my lifestyle and behavior on how I exercise, but it does a terrible job at actually determining how much I'm actually working hard during that workout. Like, I don't really trust the numbers on the, like the actual calorie burn on the order ring.

Yep.

Because it's literally worn on your finger. But so that's why when you're using the OURA ring to track your workouts, you actually want to input the workout that you did and how long you did.

It makes total sense.

You know, the, the calorie estimates are not really accurate. I don't think so if.

So, for example, if somebody has been concerned that their oura ring or try. I'm just. I'm. About any tracking ring or whoop. Or if you're tracking. Has consistently said your HRV is 20 or 25 or 30, and it's so what?

What?

If I'm hearing you correctly, that doesn't mean that's your actual hrv, but according to aura or whichever thing you're.

That's your baseline.

That's your baseline. So what you want to look at based on that number there is. What's the variation? So if you're normally 25 and all of a sudden you're 15.

Okay, wait a minute. Say okay. Okay. Maybe I'm not recovered from that trip that I just went on.

Got it. Okay.

That's when you actually need to really listen to your body and be like, okay, how do I feel? I actually, like. Let's say you traveled and went. Went across, you know, certain different time zones and you got back into town and you're like, you know what? I just got back the next day after my travel day, I should go to the gym. Well, if you're like, HRV is 10, you want to do a very mild workout. You don't want to do a bust your butt leg day that day after. So you can use these numbers to determine how well am I recovered from my lifestyle and should I be really pushing it in the gym? That's what they're kind of designed for.

That makes sense. That actually makes, I think, a lot of people feel better. I know. I'll tell you, me and my husband, like, he looks at his HRV on the. On the aura, and he's like, well, mine's 70 normally. And mine's normally in, like, the 20s. So that was the first thing. So. So if I'm hearing you correctly, that is not. You want to look at consistency versus what the tracking thing is telling you. And if you really want accurate, you've got to look at a chest strap. What does it mean if your number is jumping continually? So, like, let's say one day somebody had asked me when I asked for questions one day hers might say 25. The next day it says 70. Then it's, you know, 30. Like, it's literally all over the place. What does that mean?

It means that she's all over the place. That means that her lifestyle might be actually really great on certain days and other days she's got challenges and she's got to work to optimize. You know, basically the days where she's really low. Are the days she needs to look at what caused that drop. What did I do differently? What am I doing differently on days where my HRV is 70 versus days when my HIV is 20? Like, what happened? What's the difference? Maybe she drank the night before. Maybe she had a fight with her spouse. Maybe she had a really, really tough workout that day before and she needs to recover. So the. The beauty of these wearable technologies is not that they are perfect. It's that they can help guide us to understand ourselves better and our lifestyle better. Like, I had a CL that was, you know, dealing with one of the most stressful years of her life. Family, family challenges, parent challenges, body challenges. And I said to her, show me how much recovery you're getting during the day. And she goes, I'm not recovering at all. And so then we ran her cortisol testing, right? And she's just flatline cortisol. And I'm like, you're basically burned out, lady. And you're in a really high, high stress state every day. You're not giving yourself any opportunity to recover. And we actually, in her case, started her on 5 milligrams of hydrocortisone because she was so, so beat from the year. So. Look, like, I had a really. I mean, I had a really. By the, like, last 2023, end of 2023, my HRV was like, 65. And that's not bad for someone who's as stressed out as I am. Sure. I had the hardest year of my life last year, and it dropped to 30, right? So I have, I have a very good evidence of, like, your stress can literally drain your ability to. To respond effectively to, like, your stress levels during the day. Chronically chronic stress can really tank your capacity to adapt. And my job now is not to let that continue, but to use 2025 as a year to fully regain my strength. Makes sense, you know, but you're going to. But here's the thing. You don't want to, like, use this as, like, I failed. Like, life happens.

Life is hard.

You're gonna get hit with stuff, but that's when you really need to take care of yourself. And actually, what I did was I. I completely changed my work schedule for, like, three months and forced myself to recover. And it's slowly climbing back to normal.

That makes sense. So when I'm looking, I know you don't have yours on you, but I just pulled mine up real quick so I can look at a screen that people would be looking at. So when you.

You're taught.

When you look at the stress on the markers, when you see the dots all up and down like that, that's what you don't want. Is that what I'm understanding clearly?

Stress. You wan. There's going to be certain points of the day that you're not in that high state. You want to go down during that. You want to have a few moments during the day where you're actually calm. Like when it registers a nap. That's a good thing. Right. You may not be napping, but maybe you're just quietly reading or doing something relaxing. You don't want your full whole day to be in that high stress state because that's going to carry into your sleep because you're.

So if there is a number, like some of. Like I'm looking at mine, like yesterday it said stress an hour and 15 minutes. Is that considered high? Is that, like, that's a good day?

I mean, one hour and 15 minutes of stress, it's better than eight hours, right? Yeah.

But if you're. If you all are looking at yours and it says five hours, six hours, seven hours, that's when you have to say, wait a minute. When.

When you're looking at the majority, it's. Look, let's look at the whole day. Is the majority of your day in a stress state.

That's when you have to be a.

Little bit like, ooh, that's a little warning signal that I might be under a lot of stress. And, you know, the thing is, is the point of health is not to be perfect all the time. Right. This is the thing I try to explain to my clients. It's like, you're never going to be perfect all the time. The point is to build cap into the system so that when things are challenging, you do not break. Right. Like, I had the. I had a lot of stuff going on last year physically, and it was, like, surprising how well I was able to cope despite the challenges. But I had also built an enormous amount of capacity into my body that I was, you know, it wasn't like it was. It wasn't like it was an easy thing to do, but I was very diligent with fixing things when they were breaking. You know, a lot of people don't even have the capacity to do that because they don't have great doctors that they're working with, you know.

Sure.

And so the goal is to, like, know when things are really getting to the breaking point and pausing and making. You have to actually readjust your life to Be able to adapt to those things.

Do you want to go into, like, go on.

Well, so I want to ask you things that we can readjust and do to improve it, but I also want to ask you first about turning to things like supplements. So.

And I.

Because, for example, like, if I love.

Supplements, I'm a huge, huge fan of something.

Okay. So like, for example, if you know that things like CBD oil or 5 HTP or whatever, it is free ashwagandha, whatever somebody listening to is thinking, if that is in your brain helping you relax, is that a good tool to use or not a good tool to use?

So my. One of my friends recently recommended a product called HRV plus from the company Mode and Method.

Okay.

And Mode Plus Method. And it's a huge. It's like a hundred milligrams, 100 milligrams of CBD. What does CBD do on a molecular level? Does a lot of things, but one of the things that most people don't know that it does is that it has effects on the anandamide signaling in the brain. And what is a nandamine signaling effect? Oxytocin. So oxytocin is the hormone of safety, trust and love. So if you can take a supplement that's going to give you more oxytocin through taking a large amount of cbd, I say go for it. Like, I say do whatever you can to support yourself. Yeah, you might not pass a drug test with this amount of CBD in your body, but that it also has magnesium and curcumin and omegas. And there's a lot of evidence on omegas and CBD alone in helping with managing your hrv. So I also love PEMF mats like Centripics. Let's say you have sit in front of a computer all day long. You can sit on your centerpix Matt, and you can recharge your body. Acupressure mats, they actually do improve hrv. I've actually measured it with, with a wearable hrv. You can literally see it. Lavender oil. Fantastic. You can even take lavender. You can take it as a supplement. People encapsulate it. People use that for sleep. You can use magnesium. You can take safely up to at least a gram a day of magnesium and you can even push it up to 2 grams. But I would, I'd be very careful with that, especially if you have a heart condition.

Well, this is good news because I think people have felt shamed sometimes. Like, well, well, I. If I can't, if I'm Not a meditator. I'm not a breather or I'm not the, you know, the person. And then, oh my God, stop it.

People literally get over it. Stop comparing yourself to others. I don't care like who, what, what. I don't care what anyone else is doing for stress. I care what is going to work for you and your body. And if what works for you and your body is taking a supplement and you see an improvement, that's a good, that's great, that's a win. But like meditation is hard. Like I go, I, I mean I'm, I have two days off of meditating and I, you know, like, I feel it and like I meditate really consistently because it is like medicine. But I also do breath work. I also do yoga. And I mean you got to do the things that are going to work for you. But the big things are, are like not eating late at night. Like that's a big one. But also light signaling, circadian rhythm signaling, getting light the first thing in the morning, going outside, seeing the sun going outside during U rise UVB rise. There's an app called Circadian Life. It's a great app for tracking your light exposure. Avoiding blue light at night, using blue lockers, avoiding alcohol intake at night, spending time with friends and family, hugging, getting affection, the like. There's so many ways you can improve your hrv. Having a gratitude journal increases dopamine. Dopamine makes you feel good. When you feel good, you don't you, you have a better HRV. I love sauna, but also like a 1 minute cold shower is great for boosting dopamine too. So anything you can do to improve your hrv, like listening to classical music. Breath work. I don't recommend a lot of WIM HOF breath work when you're really burned out, but I love the app Othership. It's a great app for learning breath work. There's vagal for there's vagal nerves. Yeah.

Talk to us about what vagal means. That's like another term.

Yeah, yeah. You got a nerve coming out of your brain and it's traveling on both sides down to your gut. And the vagus nerve is, there's vagal nerve ganglia in your neck and your vagus nerve is responsible for your parasympathetic nervous system. So your gut and your brain and your brain and your gut are bi directionally impacting your stress. So if you have chronic, chronic stress, you're not going to be digesting well. So it's going to affect Your, you know, your gut health. But if you also have, like, you do something that messes up your gut, like get a bad gut infection that can mess up your brain. So it's very bi directional. Now there's a thing called a stellate ganglia block that I recently did, which they inject procaine into your nerve. Ganglia.

They inject what? What did you say?

Procaine. It's like. Okay. Anesthetic. Okay. They basically numb your nerve ganglia on one side.

Okay.

Great tool for PTSD for people that have like a nervous system that's hyper, hyper.

Vigilant and they can't seem to relax into their body. Huge fan of the stellate block. Now you got to go to someone who's good, someone who's really good, who does this every. I've never heard of this. This is wild. Yeah. It's a great tool for PTSD and just for hyper, hyper vigilance and stress. There's also this thing called neural therapy. And if you got to go to the right guy, because only there's like only 250 practitioners in the country that are actually good at it. Sure. And so it's like you got to go to a really good osteopath that knows neural therapy, but they can do this to ganglia all over your body and reset your entire body's nervous system. And let me tell you, I. I work with this woman, Katrine Balinsky, and I'm doing a retreat with her first week of May. I don't know if this podcast is going to be released by then, but I can. If people follow me and Katrine on Instagram, you can connect with us and get into one of these retreats. And there's a guy in Sedona named Dr. Tudor, and he's probably the best in the country for this type of treatment. But the last time I did it with him, I felt like I had done a 10 day meditation retreat in an hour. Wow. It was bananas. Like, I'm talking deep, deep, deep relaxation.

So when I hear these treatments that are like, I've heard these ones where they put like cold on your vagal nerve is that they're trying to basically do that, I'm assuming, but it's like a modified version.

Yeah. I mean, do it just push, push. Putting your face into an ice, ice bath every morning. Yeah. That's a great way to activate your vagus. Really. Going gargling is a phenomenal tool for vagal nerve.

Really? I didn't.

Singing. Singing improves your vagus nerve. So there's so many things you can do that are not supplements, that are just practices. Coffee enemas. You know, people are like, oh, coffee enemas are so good because they're detoxing. It's actually you. You in a small enema. Holding that enema. In that practice of holding the enema inside your body is activating your vagus nerve from the bottom up.

Wait, how does that. Okay.

Talk.

When people hear coffee enema, they.

I know it sounds weird. Like, what it's really good for getting your nervous system to regulate how it doesn't make.

It doesn't make logical sense. Like, you're putting caffeine.

Your vagus nerve goes all the way to the bottom of your butt.

Okay.

And so when you're. It's like exercising your vagus nerve.

Huh?

Because you're basically preventing. Like you're holding. You're basically keeping yourself from going to the bathroom, and then you eventually go to the bathroom. Right. It's kind of like weight training for your vagus nerve.

So if you actually have to go to the bathroom and you hold it, would that do that?

You hold it? Well, I wouldn't do that, actually. That's not as healthy. Because you're holding in the coffee too, right?

Yeah.

And you're getting all the polyphenols from the coffee into your. Into your portal Venice system. So there's a lot of other benefits to coffee enemas, which I think a lot of people underestimate, but they're a staple in naturopathic medicine. And I'm not a naturopath, but I use naturopathic medicine. Yeah, you don't want to use hot coffee. You want to use mold. Free, organic only. And you brew it and then you get it to body temperature and then you just put like a. You use even like, it's just a half cup. You don't need a lot. It's kind of a staple in detoxification practices. Also. Massage is really great. Just a full body massage, body work. Yoga, like especially yin yoga. Fantastic for hr.

Yin yoga.

Yin yoga is when you do long holds of static poses, usually while sitting and lying down, that are really stretching the fascia. And it's not designed to be like intense physical exercise. It's designed to be a lot of deep breathing and holding. So you're really stretching all of this tension out of your fascia. Great, great practice to incorporate as well as even just believe it or not, chewing gum activates the vagus nerve.

Chewing gum?

Yes. Yeah.

This is wild. I mean, this is I don't think this is talked about enough with the vagus nerve. I think a lot of people are. So I want to understand this a little bit. So you say your vagus nerve is in your neck, but it runs down to your.

Comes out of your brainstem. It goes into your neck. There's. There's a ganglia, which is a bunch of nerve terminals.

Okay.

That are in your neck, but there's also nerve ganglia all over your gut. You know, there's nerve ganglia all over your body.

Yeah.

So the whole point of neural therapy is that you're literally kind of rebooting the autonomic nervous system system.

That makes sense.

You got to go to somebody who knows what they're doing, because it's definitely.

Not or it's hit.

Like, I went to somebody that wasn't. Didn't know what they were doing, and I ended up having the exact opposite effect.

Yeah, that would make sense.

I had, like, a full sympathetic reaction. I was. I was in a stress response. Like, this guy had. He's a. He's a beginner. He had no idea what he was doing.

So you have to make sure somebody's really trained in this and knows what they're doing here. How do. Okay, so back to supplements for a minute. Like, when we. You talked about things that can. Whatever can calm you is great. So if. If it's CBD or THC or whatever it is, it's calming you. That is good. And, like, kind of no judgment. But what about the opposite? What about people that rely on stimulants? Or, like, let's talk about caffeine or things that spike your cortisol. Are we damaging our HRV by doing that?

If you are addicted to caffeine and you're drinking it all day long, like, I saw the movie Baby Girl recently. It was great film. And Nicole Kidman had, like, seven cups of coffee that day. And this guy's like, how many cups of coffee have you drank? She's like, seven. And he's like, it's not good for you. And it's funny because people. When I was younger, when I was in medical school, I used to.

Basically.

Drink cups of espresso, like, cups. And so, like, I have a cup of coffee here today, and what I do now is I take a third of coffee, caffeinated coffee. I take a third of decaf coffee, and I take a third of Kamana mesquite. What's that? I'm doing a third of caffeine.

Okay.

When I drink a cup of coffee, right? What's Kamana is mesquite. It just tastes amazing. It's like you can actually just drink Kamana on its own, but it's a product that basically is. It's like coffee, coffee alternative and mesquite powder. You just brew it like coffee.

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Trained myself in naturopathic medicine, Chinese medicine, energy medicine. I mean, I'm actually studying for a board exam right now for allopathic medicine. And it's so hard.

I love it, but I love.

Yeah, I'm brushing up on all these things because, like, you want to be. You want to be able to take as many tools to a patient as possible. But I mean, I'm looking at a person's entire life. Like, I'm not looking at just their body. I'm looking at who are the people that they surround themselves with, what is their relationship status, what is their sex life like, what is their. What is their nutrition look like, and what does their gut health look like? I mean, and I'm breaking. I mean, I'm going deep into people's. You are.

I appreciate your path so much because, I mean, gosh, I have so many doctors on. On here. But what I find is there's, like, typically. And I'm very overgeneralizing right now, but I'm just going to say it. I find this big divide between, like, traditional Western md, like, this is the box I stay in, and then this other naturopathic group that's like. And I. I really am hungry. And I think a lot of us are hungry for the combination. Because you. You become a doctor because you want to help.

Yeah. I mean, studying for this board exam has made me a better doctor because you need to know what you know and what you don't know, and you need to know when to refer someone. So, like, I had a client that had a really weird skin condition, and I go, I have no idea what this is, but this looks like cellulitis. And I think you need to go to a derm immediately because we need to rule out that this isn't, like, a serious problem. Yeah, go to the derm. The derm diagnosis. This person with this rare form of, you know, like, cellulitis, and turns out it's not treated with antibiotics. And I was like, okay. They say, the guy. The doctor says, look, this is incurable, and you're going to live this the rest of your life. And I go to the guy, okay, first of all, we know what you've got, but don't listen to them because we're going to fix it. Person's in remission after working with me, of course. They're in total remission. So it's like, you don't. The doctor of the future is ideally going to recognize that there is value to the mainstream system, but there is absolutely. So much value to understanding health. The thing is, the mainstream system is a disease system. So if you don't understand disease and you don't. And like, like, for example, if, like, if you don't understand disease, like, you might miss something. Really. Like, I had. I had a friend who came to me and said, I've been seeing this doctor for a year and my gut is not getting better. And this is an alternative doctor, she's been saying. And I go, well, did they do a stool study? And then she goes, I haven't even done a stool study. And I go, oh, my God, you have to do one immediately. Yes, she does a stool study. And it turns out she has H. Pylori and she's got, like a bacteria stomach that can cause cancer, which is.

Very important to know and.

Do this. So, like, the reality is, is that both sides, if they're not seeing each other, like, they. You need to see what both sides know and understand. And I just happen to be really lucky that, like, I have a very special practice that I only see 10 to 20 patients at a time. I go really deep with each other.

Do you like more concierge medicine?

So definitively high, highest end concierge. I'm like, but a woman. Yeah. If Peter Thiel worked with you directly and not had his team manage you. So one on one weekly, bi weekly. And I'm really working on specifically identifying, okay, what are your goals? What are your problems? Let's systematically go through all of these and fix them. Like, that is not something you typically see.

No. You know, it's brilliant. And I hope, I honestly hope more and more doctors take this approach because otherwise it does stay untouchable. Right. Like a lot of people, we need.

A lot more doctors for this to happen. We need to make it cheap to go to medical school.

And we also need doctors to go to medical school, not be afraid.

The government should subsidize hundreds of thousands.

Of doctors, and we need doctors to not be afraid of stepping outside the box. That's the other thing I think that goes on is that a lot of traditional doctors get very like, I can only do this because this is what I learned. So I think that's just my opinion.

I'm literally developing what's called a private medical association, so that when you sign up to work with me, you're literally signing a contract that says, I am aware that you are not working with me in just a fully mainstream way. I am aware I'm signing on to some alternative treatments, amazing experimental interventions, and that I Am not going to bill you. I'm not going to like, I don't take insurance and I'm never going to.

Take insurance because then otherwise insurance succeeds the treatment.

And there's really no reason because literally the overhead and the way that they reimburse is no. Isn't going to go near what I charge people. So it's just not worth my time.

So before someone tunes that conversation out right now, because I want, I want to, I want to say this.

Well, I want to go back to the HRV stuff and really specifically talk about things that anyone can do without any money.

Yes, I want to do that. But I also, I just want to, I got to say this one little thing because I, this will, this will drive crazy. Like so a lot of people, they'll hear things like this and they'll go, well, this is untouchable. I can't, I can't work with a doctor like that. And I'm going to call baloney on that because we're going to talk about some natural things you can do. But I also want to say we have to stop letting insurance dictate treatment because if we let insurance dictate treatment, then what happens is your insurance company doesn't actually care about you, so we're letting that dictate treatment. And now what happens is you have bigger problems later. And I'm saying this because I'm not a doctor, so I can say we have bigger problems later that do end up costing you more money and time. So I'm going to say it's very important to take this seriously and say I need to get the help that I need despite what my insurance is dictating and really take that seriously and listen to the natural ways you could do it that don't cost money. Because this is going to be really critical. If we continue letting businesses just dictate our treatment, then we get into more trouble. That's how I feel.

I mean, I think that if insurance company people just need to understand insurance, first of all, they're not invested in your longevity because you may bounce around to different insurance companies over the course of five years and they're not going to be responsible for you in 20 years, so why would they care about you, your 20 year version of you? Second of all, we do need some sort of public option. And we do, and it will be rationed just so you know, it's going to look like Canada. But we have a public option for the poor and the old. We don't have a public option for Everyone else. And we need that. And that. That is something our country does need to do that comes. There will be a massive divide between what you can get through the system and what you can get through someone like me.

This is going to happen in our lifetime. So don't expect to get what I do from the system. Totally idea. And the thing is, the system is designed for when you're truly broken. So you have to. You have to literally have diabetes to get a continuous glucose monitor. But guess what? A decade ago, I started using glucose monitoring on healthy people. And a decade later, the glucose monitors are selling them to healthy people. Right. So the thing you get from working with a doctor like me is we're 10 to 15 years ahead of everyone else.

That's true.

You know, and that's.

Yeah.

But you get what you pay for. So.

So when we go, I want to go back to talking about some natural things we can do to improve our health, which ultimately, HRV is a marker of health of what? And if. And I want everyone to hear it wasn't. She didn't say that. You have to be scared if your tracking ring is saying your number's low or your number's high. That's not. It's. It's the variability. And then let's talk about how we can actually fix that. I want to go back to something you said about alcohol, because I do know women get very defensive here, and somehow along the way, we got misled to believe alcohol is healthy for us. And it is not that.

It is the opposite of a carcinogen. It causes cancer. Okay. So there's literally no amount of alcohol that outweighs the risk on that. None.

Everyone here yet.

It's damaging your gut. It's get. It's damaging your blood vessels. It's making you look old, it's aging you. Like, it's literally making you look 10 years older than you need to look. So why would you consume this? Because it's fun and it tastes good and it's social and it's in, and it's an enjoyable thing. But I think that. I mean, look, I'm. I'm a big fan of, you know, like, CBD products. I really like the company Little Saints. They make a hemp drink that's fantastic. But look, I think we need to reschedule a lot of things that are considered to be bad. I think microdosing marijuana is better for you. Like, one milligram of marijuana is better for you than a glass of wine.

Molly, where do you think this came from like, like somebody's gonna listen and go, well, in Europe, they drink and they're healthier. And there was virtual in red wine. It's healthy. Like, how. Where did this even come from that people were saying alcohol was healthy for us?

There was veritrol argument, you know, but also it, you know, if somebody does have a really strong history of stroke or heart disease, and then the rest of the family history is just. They've got nothing else. Like not a single episode of cancer in their family, you might benefit barely from like a glass of wine a.

Day, but so very small.

The other thing I would say is that Europeans spend a lot more time socializing and they spend a lot more time with friends and family and walking and walking. And so, like, I do think that there is some very mild benefit to alcohol because if it means that you're going to actually get human interaction. But I would say that if your HRV is running low consistently, it's one of the simplest things you can do to improve it.

What about somebody that says, well, I'm stressed, and you just said, stress is not good, and a glass of wine at the end of the day or a bottle of wine helps me unwind. What do you want them to know?

There's a big difference between a glass of wine and a bottle.

Okay, so let's start with the glass.

You know.

Look, you. What I would do is I would tell them you need to start running some experiments and actually see what happens to your HRV when you don't drink at all. And what happens to your sleep when you don't drink at all. And what happens when you drink a bottle of wine and you tell me what. What's happening in your body? Like, is it really helping you manage stress? If your sleep is garbage and your HRV is tanked, Is that really true or is it something you're telling yourself?

Very key.

Yeah, so just.

I know people get very defensive with the alcohol and. But it's.

It's, you know, that would be like.

Us saying that cigarettes are okay or. I mean, it's just not okay. It's just the research just shows how detrimental is to our health. So we have to point it out, share it.

Yeah. I mean, also, I think a lot of people struggle with being okay by doing nothing. Right. Like, a lot of people struggle with just being with themselves. And I think that's the bigger thing we need to talk about is.

Yeah, let's talk about that.

You know, like, that's very true. Being with you alone without a crutch like why do we depend on our phones? Why do we depend on our alcohol? Why do we depend on all these things that like, why is it so hard for us to just be ourselves?

Why is it.

I think a lot of it is that it's, it's the messages that were sent by the media. So like the best thing you could do is stop watching the news and stop, you know, scrolling on Instagram and like, like, honestly, like discipline is freedom. If you can learn to like have a one hour wind down routine where you, instead of drinking a glass of wine, are doing yin yoga, are doing stretches, are doing breath work, are doing things that actually nourish your brain, you won't, don't reach to the crutch because you won't need the crutch. You know, can you talk about that for a minute?

Because cell phones specifically, I think people don't realize they don't put them in the addiction category. And it really is an addiction. And I'm guilty of how I feel.

When I use my phone consistently and I feel like garbage. Like I do not like the way that I feel when I'm on my phone non stop. So I've been really like trying to examine like after I finish scrolling for a while, like how did that make me feel? And honestly what it mostly does is make me feel like I need plastic surgery.

I don't need plastic surgery actually. Why am I being told that by my phone? Funny. You know, and it's like, that's funny because we, we, we are, we're. So I've been, I'm doing, I'm designing a lecture on health.

Okay.

I'm giving it a longevity conference and it's a first principles talk on what is health and life is energy plus information plus structure. So if I go into this and if you, if you optimize energy, if you optimize the information that, that you're, that is going. There's, there's literally chemical messengers inside your body. Hormones, neurotransmitters.

And signals from the outside world, from our sensory experience and also the thoughts, feelings and emotions that we feel. This is all part of the information and the structure as a physical body. Right? And every single cell has all of these drivers of aging that are part of the structure of each cell. And then there's all these different organ systems. So I can literally tell you how to optimize health by showing you what life is and how to, how to actually address each facet of life. But the thing that people forget the most is the information that's being sent to our sig, to our brains, through our phones, that information is changing the way we feel, it's changing the way we think, it's changing the way we emote. And if you don't actually start understanding the signals going into your brain that are sending you positive health messages or negative, you know, self worth feeling, like things that basically make you feel bad about yourself, then you're missing a big piece of health. It's the. It's the messages you're getting from your friends, it's the messages you're getting from your partner. It's the messages you're getting from the media, it's the messages you're getting from the food that you consume. So, like, you got to think about the information that is going into your system and change that information if it's not working for you. So, like, I get this guy Adam, who runs Instagram. He regularly asks the audience of Instagram, like, what are your questions? And I keep asking him, adam, how do I reset my algorithm? Because we need to have more control over these algorithms messages, because they are changing the way that we perceive ourselves and others.

Does he answer?

He doesn't answer.

I think TikTok's even worse than Instagram. So you said something that's really. I keep looping on.

Yeah.

And this has been years, but always a different thing. You said that people are trying to escape themselves. They're not okay with themselves. And I think years ago it was other things. Now, cell phones weren't a thing 20 years ago, but. But it's always something. Like, maybe it was TV then, or maybe it's drugs, or maybe it's alcohol. It's always something I'm gonna escape. Some people are just workaholic as an escape. What is that? Like, why are we all so trying to escape ourselves?

I mean, this is a spiritual problem, right? This is going into the psycho spiritual piece of healing. Like, we are in a crisis of connection in this country and we are disconnected from ourselves. We are disconnected from our partners, we're disconnected from God. And the problem is that we think that we're connected through our phones, and our phones have given us this false perception that we have friends. But most of your friends are actually acquaintances. Like, the number of people that will actually show up for you when you need help is actually a lot smaller than it used to be a decade ago.

It's not your Instagram followers.

What happened with our lives with the pandemic is.

We had a massive disconnection moment in Human history. And it was, I believe, terrible for human health what happened to us. So religion used to be a source of human connection. Like I, I, I'm a, I was raised Christian, but I'm technically Jewish. And I really recently started going to Shabbat dinners every Friday because I needed more friends and I needed more connection to God. And I found it through a community of Jewish people in Jackson, Wyoming. But religion is something that a lot of people have actually moved away from. But the, one of the main benefits of spirituality that is in the clinical literature is actually the ritualistic gathering of people to connect with one another. Wow. It's, it's, it's. Look, I think part of it's about a, part of it's because I believe God is love. And love is this motivational drive to connect with people, to connect with others. Like it's love is literally a motivational force that brings people together. And we come together, we share information, we share resources, we share human, we share physical affection and touch. And that actually sends safety signaling to the brain, which, it releases oxytocin, which is an anti inflammatory, it's an antioxidant, it's a, it's protective to the heart and it's protected to the mitochondria. So we fundamentally need human connection to thrive. And we are further and further connected from one another because of our phones. And then we also are so distracted by all of this that we can't sit with ourselves and just be, and just feel. Because what am I going to feel if I actually am not right looking at what's on my phone, what am I actually going to feel? What you might feel is, oh, that unresolved trauma from my parents, that fact that I just don't like who I am. You know, like people are afraid to feel what's really underneath the surface, but that's how you heal. It's feeling it all. What do you give?

Because I don't. What advice do you have? Because I think, think, I think we have a chronic problem with, with cell phone. Me included. I'm, I'm raising my hand first. My phone's right next to me. It's, it's everywhere I go.

Yeah.

What advice? Like, do you have any practical advice for that? Because I think, don't be honest.

Start with 20 minutes before you go to bed where you don't have any phone. Start with something, something as small as 20 minutes. And I don't care what you're doing during that, during that 20 minutes, but I want you to do something that is on, not on your phone.

So read a book.

Or I want you to read a book. I want you to journal. I want you to do breath work, preferably not even a book for, for a moment. Like I really want you to. I want people to learn to be.

With themselves, to connect to themselves.

So just connect and then. And I would prefer if you even journaled over reading. And I definitely believe in reading, but I don't want reading to become another escape. Got it. Can you just be with you. I don't care if you color in a coloring book, but I want you to do something that makes you sense yourself and think and feel and process your day. Okay. And actually release all the day stressors.

And I like that you just said that because I think when we hear just you're on our phone too much, people go to this like I have I'm doing something wrong. But I like how you just kind of added something in. You said no. Instead of being like you're not gonna be on your phone, let's add in 20 minutes of something else. Or let's add in gradually an hour.

The best way to break a bad habit is to replace with something else. That's great. So it's really, really good to like go analog, you know, like go on a 20 minute walk, you know, after your meals, like do things that don't require you to be always on. Because I telling you, an hour of my evening practices and I sleep like a baby and I wake up stressed out and I feel awesome. It's like the best recharge ever. And the funniest thing is I learned these evening practices through this guy Sadhguru, which I believe is running the largest cult in the country. In the world. He's got like 20 million followers. I have a cult member, but I, I really, I mean I really believe in God and Jesus. But I did learn breath work and meditation and yoga through going to this guy's crazy retreats. So like I would, I mean I, I do recommend meditation retreats, but you had to work. You have to work up to those. You know, Joe Dispenza has some fantastic retreats. But like you people think is people. People are literally sitting with superpowers in their brains and they're just not even aware.

I agree with that.

It's wild.

And it's like you don't get to.

Those superpowers by scrolling.

No, you're right.

To the superpowers by training. And it's like Jedi training. My, my meditation guru, this guy in Maui, he was like, this is subtle bodybuilding. This is training your ability to master your mind. And I was like, once he told me I was a Jedi, I was like, oh, my God, I'm so into this. Like, I. I have. Through meditation and through yoga and through these practices and these breath work practices, I have uncovered skills and capacities that I didn't even know I had that I never would have discovered if I was just only on my phone. Yeah. So just realize it's not about discipline for the sake of just discipline. It's about the freedom that you get from discovering that you have mind over matter. Like, that you can do things that you would never think possible because you have actual mastery of yourself. So good. So good.

Molly, I like you. I like everything that you're sharing, and it's so good. Tell us about your. Your book. Is it. Is it out? It's coming out.

Oh, yeah, it's out. It came out in 2023. It's called the Spark Factor.

Okay.

And it's really a book fundamentally on mastering metabolic health because insulin resistance is underneath almost all chronic disease. Yeah. I was insulin resistant in my early 30s. I was freaked out, and I had just gotten off of Adderall. I was just. Just gotten off of gluten. I'd find out. I found out I had celiac, and I was eating a lot of sugar and a lot of carbs, and. Yeah. And I ended up insulin resistant. And if I hadn't fixed that, I would be on my way to chronic illness. And I'm so freaking lucky that I did, because I was able to overcome chronic. Chronic fatigue syndrome. And I literally look younger now. I. I literally had a meeting with a woman who met me many years ago, and she goes, I do not understand how you look younger now than you did when I met you. And it's because the more energy that you have available, the more you shine, the more you. You light up. And the thing is, is that I have had to learn a lot of these lessons on my own. So I wanted to build a book that would at least teach people, first and foremost, you gotta fix your metabolism, because if your metabolism is broken, you will get sick. It will happen. It's just not. It's not if, it's when. And so cancer, heart disease, heart disease, diabetes, and dementia are all linked to insulin resistance. And this book is first and foremost designed to help you get your energy back through fixing your insulin resistance. Beautiful. I want to write another book on stress because I really feel like I've learned a lot that my Stress section of the book is anemic compared to the metabolism piece. And I really, really want to write a book on stress and burnout because people don't know how to fix their hypoth, hypothalamic pituitary, adrenal axis. And I have literally burned out so many times that I know how to fix it at this point. So, so good. But I want to go back to the thing we didn't really talk much about, which is the, the, the, the simplest way to fix hrv. Yeah. Is understanding zone two and zone five training. So you need both to optimize your hrv. So how do you get your zones? You take the number 222 minus your age and then that's your zone five.

Okay.

And then you multiply that number by 0.7 and that's your zone two. And you want to train in zone two, which is light cardio at 70% of your maximum heart rate, three times a week for 30 minutes. What do I do? I do rucking. So I would, I put up. That mean I put a 15 pound backpack on my back.

Okay.

And I go on a walk and it's hard because like I'm like by the time that walks over, I'm kind of huffing and puffing a little bit. But 30 minute walk three times a week, wrecking backpack, you're gonna be fine. It's not hard. It's not hard. I'm telling you.

So you take 222 minus your age. Like I'm 53. So minus that and then times 0.7.

That'S your zone two.

Zone two. Okay, got it.

Manage your age, that's your zone five. So zone five is when you do hit training. And so five to 10 minutes once or twice a week when you do zone five. And if you really want to go and optimize like weight and metabolism on days when you do zone five training, which is literally 10 minutes of exercise at. In, in like so top it. I would be like, you sprint as fast as you can for a minute and then you rest for a minute.

I do that with a Carol bike and I love that. And I shared about that.

I'm not. It's like a 10 minute workout. I'm telling you. It's not impossible.

Amazing.

So this is the day when you would do a keto day when you would go fully like less than 40 grams of carbs. If you do that twice a week, you're going to build metabolic flexibility because you're going to be breaking into your fat and then you're gonna be burning, burning fat on days like that. So that's the day when you do the training. Zone five and zone two. You know, I do zone two probably two to three days a week. And it will take off weight really fast, too, if you just start doing this. Like. And then I also weight train. I really believe in weight training. I think it's almost impossible to age well without weight training. Like, I agree. Can't do it. You have to do it. Like, ladies, if you're listening and you're going through perimenopause, you need to lift weights. You have to do it. It's time.

Molly, this is so good.

Where do.

Where do people. Where do you want them to follow you? Where do they learn more? I know you. You do take some concierge patients, but, yeah, absolutely.

Find me at drmoly Co.

Okay.

R M O L L Y dot co. And I would say the last thing I want to add is, like, everybody needs to learn breath work. Like, you got to learn some form of breath work. The simplest is lay on the ground and watch your belly rise and fall. That's diaphragmatic breathing. The second is. Is like box breathing. Four breaths in, hold four breaths. Four breaths out, hold four breaths. It's a box, right? Four breaths for each whole. Each step of the breath. But then there's also.

When you do alternate nostril. Alternate nostril breathing. So you breathe in.

Wait, so I'm trying to remember how to do this. You breathe in and.

And breathe out the other side.

You hold on. So breathe. Breathe out, Breathe in. And then you switch nostrils. You breathe out. You breathe in, you switch nostrils, and you're holding each. So this one is breathing out.

Yeah.

Breathing in. Do that for four minutes and tell me you're not the most relaxed. That's so in your entire life. My. My breath work sequence requires me to do about six minutes of that a day. Yeah. And it changes your nervous system. So this is an ancient form of breathing that you can learn, but these are very, very simple things that. And also I do. Part of my. My breath work sequence requires me to own for 21 breaths. So, like, you're going, oh, if you do that, like, literally, you're just activating your vagus nerve. Okay, so all of this is on my website. There's an HRV protocol.

And, you know, there's instructions on coffee enemas. I basically given it all to you in the podcast.

We gotta go explore her website.

But, yeah, you can find everything on my website. I've got a web store Dr. Molly Co and I'm also on Twitter at Molly maloofmd or X and I'm on LinkedIn at Molly MaloofMD and my Instagram is Dr. Molly Co and I do answer all my messages. So that's amazing.

Yeah, you're amazing. Thank you so much. My God.

Thank you.

Natalie.

Thanks for tuning in to Midlife Conversations today. If you enjoyed this episode, please share it and tag me Natalie, Jill Fitz and our guests on social Media. The best way to support the show is by leaving a review. Send a screenshot of your review to supportnataliejillfitness.com for a free digital DM ASR journal download. And just a friendly reminder, I'm here with a microphone, not a medical degree. Half the time I'm sharing things that I read on the Internet or learned just as you were learning it while I'm interviewing the guest. I'm not an MD or your therapist or your mom, though I do give excellent mom style pep talks. This podcast is purely for entertainment, curiosity and educational purposes. When in doubt, please ask your own own doctor. For advertising inquiries, contact sales admintegory3ca and this podcast is not intended to be a substitute for professional medical advice. Always seek advice from your physician. Some episodes of Midlife Conversation may be sponsored by products or services and I may receive compensation for advertisement of your purchases through affiliate links.

Sam.