Using Wearables to Improve Health, Recovery & Performance PH221

Healthcare practitioners and wearables experts provide insights on several different types of wearable devices for CrossFit and health, including trackers for workouts, sleep, recovery, and blood glucose.  The panelists share the most useful metrics to track, why personalized data and experimentation are so crucial for improving health and performance, and actionable tips individuals can use to improve their biometrics.

In this episode of Pursuing Health, host Dr. Julie Foucher hosted an panel of healthcare practitioners and wearable experts to provide insight on various types of wearable devices. Levels founder Josh Clemente represented the Levels CGM wearable, and explained why personalized data and experimentation are so crucial for improving health and performance.

Consider the holistic side of wellness

As a SpaceX engineer, Josh was working on life support systems without giving a thought to the multifaceted needs of his own body.

It started at SpaceX. So I’ve been interested in human performance from a selfish perspective for a long time. I just wanted to be able to run fast and lift heavy things, but I had never thought deeply about nutrition and the holistic side of wellness. When I was at SpaceX, I was developing a life support system that required me to get exposure to the way NASA’s thinking about maintaining health over long durations when you don’t have access to medical care. It really started me thinking on what am I doing to ground my choices and data? Everything I do is based on emotion or what I saw someone else doing at the gym. There was nothing objective. At the same time, I’m in a very stressful part of my career and feeling burnout coming on quickly.

Track what you don’t want to fail

Josh was originally denied access to a CGM. Once he got one, it transformed his lifestyle.

I spoke to one of the doctors that was on the program with me and they recommended that I start tracking my blood sugar. So I got a finger prick device. I started pricking my finger obsessively and tracking it in an Excel spreadsheet. It wasn’t very useful to me. Then I read about CGM in Robb Wolf’s book actually, Wired to Eat, and that immediately changed things for me. So I went to my doctor, I asked for a CGM. I was promptly turned down and denied because I did not already have diabetes. The argument was that you need to worry about tracking blood sugar, if you have a blood sugar problem. But you do not. And so, therefore, you don’t need this. As a systems engineer, my thought process was, well, actually you track what you don’t want to fail. You don’t track it after it’s failed. That’s the way that you maintain systems. And so, I’m having energy system issues. Metabolism is the energy system. And so, glucose is the primary fuel. I should track this. So eventually I did get a CGM and I found out that I was prediabetic, and that’s when everything changed. So I completely transformed my lifestyle. Nutrition, exercise, sleep, stress, everything changed from one data stream. And so, I wanted build levels to be the whole process in one.

Metabolic health underpins all health

The sum total health is all about context, encompassing much more than just what we eat.

I consider metabolic fitness and the way that I’m generating energy to be core and the foundation under which physical health and mental health are built. All the tissues in our bodies need to be able to generate energy efficiently to operate efficiently. So if you can’t do that, you can’t be peak physical fit, peak mental fit. And so, I start there. I start with what am I putting in my body and why and having objective data that drives those decisions and is contextual. The most important thing is that we look at the glycemic index and it’s an average of averages normalized to a hundred. How do you know what to eat for lunch after you’ve had a red-eye flight? Because it’s going to be different than what to have for lunch when you’re well-rested and have been training for multiple weeks, effectively. And so, it’s that context dependency that I think is most important.

Why personalized diets are key

A seminal study showed that every person reacts to a given food in a unique way. That’s why there is no “one size fits all” diet.

One of the most interesting studies that really confirmed my goals with the company when starting it was I read about this Weitzman Institute trial. It was in 2015 in Israel. They took 800 people without diabetes and put CGMs on them, and then tracked what happened over the course of seven days. They gave out these standard meals. So everyone ate the same foods. Then they were able to later look at that dataset. They showed that two people in this dataset could eat the exact same two foods, in this case, it was a cookie made with wheat flour and a banana, and they could have equal and opposite blood sugar responses. So a big spike from the banana, flat from the cookie for one person and the exact opposite for the other. The implication there is that the hormones that respond to the foods we’re eating, the macronutrients that are breaking down into our blood, could also be equal and opposite. So one person’s experiencing a big influx of insulin, which could be causing anything from inflammation to weight gain, to cognitive cloudiness. These are all the sorts of qualitative experiences, and to each their own in terms of what they’re focused on. But if this is truly happening, the hormones downstream could be totally opposite for two of us. That’s where the personalization element comes in.

The dangers of oatmeal

Long touted as one of the best breakfast choices out there, oatmeal is actually a food that causes glucose spikes in most individuals.

It’s funny you bring up oatmeal as well because in our dataset, the number one offender for postprandial, post-meal elevations is oatmeal. Cardiovascular disease is very closely related, as you all know, to inflammation, which is also well-correlated with blood sugar variability. And so people who are trying to avoid heart disease are potentially, or even already have cardiovascular disease, are oftentimes referred to the heart healthy oatmeal as a morning breakfast option. If you Google the healthiest options for breakfast, oatmeal’s up there on all of them no matter where you find it. It turns out that a lot of these people likely are doing damage as opposed to serving their own goals.

Move after you eat

If there is once piece of advice Josh could give, it would be to go for a walk after eating a meal.

One of the most impressive effects that I’ve seen that anyone can replicate today is light movement after meals. So if there’s one thing I would say, start today, it’s after you finish dinner, put the dishes in the sink and go for a walk around the neighborhood. It’s dramatically different, but consistent across the population how much this can improve the glycemic response of that meal. It’s just your posterior chain, big muscles pulling glucose right out of your blood as you’re moving. It’s something that holds for everyone. It’s simple and it’s great. It’s good for your mind, it’s good for your body, and it’s easy to do.

Look for patterns

Every person should focus on the patterns available in their own dataset.

The beauty of wearables generally is that they’re allowing us to create population scale N of one experiments, which all stack up to changes across society. But the individual should focus on their patterns and trends. Comparing absolute numbers baseline-to-baseline is not really helpful for you. You can’t magically change it, but you can see what is within your control to improve. Obviously, I don’t know enough about HRV, but I do see this across the board, that people tend to compare on the absolute values and get too fixed on them. Anyone in wearables, in the wearable industry and bringing this stuff out should help others recognize that it’s the patterns and trends that you can influence.

Josh Clemente:

What am I doing to ground my choices in data? Everything I do is based on emotion or what I saw someone else doing at the gym. There was nothing objective. At the same time, I’m in a very stressful part of my career and feeling burnout coming on quickly. I was having these fatigue episodes. I would have very, very … Like basically mood disorder. I would just be irritable. I would want to go home. I would want to crawl under my desk and sleep, all these things that were strange to me and couldn’t be explained because I was in pretty good physical shape.

Josh Clemente:

I spoke to one of the doctors that was on the program with me and they recommended that I start tracking my blood sugar. So I got a finger prick device. I started pricking my finger obsessively and tracking it in an Excel spreadsheet. It wasn’t very useful to me.

Josh Clemente:

Then I read about CGM in Robb Wolf’s book actually, Wired to Eat. That immediately changed things for me. So I went to my doctor, I asked for a CGM. I was promptly turned down and denied because I did not already have diabetes. The argument was that you need to worry about tracking blood sugar if you have a blood sugar problem. But you do not. And so, therefore, you don’t need this. As a systems engineer, my thought process was, well, actually, you track what you don’t want to fail. You don’t track it after it’s failed. That’s the way that you maintain systems.

Dr. Julie Foucher:

Hello and welcome to Pursuing Health. I’m Dr. Julie Foucher, family physician and former CrossFit Games athlete. Here I bring you information and inspiration to help bridge the gap between fitness and medicine and support your journey toward your healthiest self.

Dr. Julie Foucher:

In this week’s episode, I’m sharing another panel I hosted on behalf of CrossFit Health at this year’s CrossFit Games. This particular panel was on the topic of wearables, and I was joined by a super intelligent group of self-experimenter experts, Kristen Holmes, who’s the Whoop VP of Performance Science, Josh Clemente, who’s the Founder and President of Levels, a continuous glucose monitor company, Dr. Nick Nwabueze, a physician with SteadyMD, Dr. Mike Mallin, one of the Co-Founders of CrossFit Precision Care, and Dr. Katina Thornton, an anesthesiologist.

Dr. Julie Foucher:

We talked about what the panelists have found to be the most useful metrics to track, why personalized data and experimentation are so crucial for improving health and performance, and some actionable tips that individuals can use to improve their biometrics.

Dr. Julie Foucher:

This panel was originally published on crossfit.com on October 7th, but I’m excited to share it with you here. Stay tuned for upcoming panels on cancer, genomics, and pregnancy in the coming weeks as well.

Dr. Julie Foucher:

Before we dive into the episode, I do want to make it clear that this podcast is for general information only and does not provide medical advice. I recommend that you seek assistance from your personal physician for any health conditions or concerns. With that, we’ll get to the episode.

Dr. Julie Foucher:

We are going to be talking about the topic of wearables, which is very new and exciting, especially in the CrossFit community and a lot of applications. So let me first introduce our panelists.

Dr. Julie Foucher:

First, next to me, we have Kristen Holmes, who’s the Vice President of Performance Science at Whoop. She works with top researchers and hundreds of tactical pro and collegiate athletes and teams to optimize training, recovery, and sleep.

Dr. Julie Foucher:

She has an impressive athletic resume of her own as well. She’s a three-time all-American and two-time Big 10 Athlete of the Year at the University of Iowa, competing in both field hockey and basketball, as well as a seven-year member of the US National Field Hockey Team.

Dr. Julie Foucher:

She holds a Master’s in Psychology and Sports Performance from the University of the Rockies and is a PhD candidate in Psychology at the University of Queensland. That was a mouthful.

Dr. Julie Foucher:

All right, next, we have Josh Clemente, who is the Founder and President of Levels, a continuous glucose monitor company that helps people take control of their metabolic fitness by using real-time data on their blood glucose levels. Prior to founding Levels, Josh led the development of pressurized life support systems at SpaceX and worked as a senior design engineer at Hyperloop.

Dr. Julie Foucher:

He’s also a CrossFit level two trainer and is passionate about fighting chronic disease through the use of data to provide personalized evidence-based insights. So thank you, Josh. All right. Next, we have Nick Nwabueze. You’re going to have to help me again. Nwabueze.

Nick Nwabueze, MD:

That’s good enough.

Dr. Julie Foucher:

All right. He’s a board-certified family medicine physician. He completed his medical school at the Ohio State … I can’t even believe I just said that as the University of Michigan grad, at the Ohio State University College of Medicine and finished his internship and residency-

Kristen Holmes:

Big 10.

Dr. Julie Foucher:

Yeah, lots of Big 10 up here, at Adventist Hinsdale Hospital in Illinois. He’s also a CrossFit level one trainer. He believes medical school underprepares doctors to help people make significant life health improvements through their nutrition and other lifestyle changes. He’s passionate about learning more about how diet and movement affects overall health. So thanks, Nick, for being here.

Dr. Julie Foucher:

All right, then we have Mike Mallin. Dr. Mike Mallin is the Chief Medical Officer and Co-Founder of Wild Health. He attended the University of South Carolina School of Medicine, completed his residency at the University of Utah, and now practices in Bend, Oregon. He is a board-certified emergency medicine physician and completed his fellowship in point-of-care ultrasound.

Dr. Julie Foucher:

He’s the co-author of two textbooks and taught thousands of other physicians through online education. His current obsession is the science of longevity, helping people live as long as they can with the highest quality of life obtainable. So thank you, Mike.

Dr. Julie Foucher:

Finally, we have Dr. Katina Thornton, who is a board-certified anesthesiologist. She completed her medical education at UT Southwestern Medical School. Following a transitional internship at Methodist Medical Center in Dallas, she completed an additional training at the John A. Burns School of Medicine in Honolulu. She attended a year of law school also at the University of Hawaii before returning to Dallas to complete her residency in anesthesiology and pain management at UT Southwestern.

Dr. Julie Foucher:

Dr. Thornton is also a level two trainer, CrossFit level two trainer, and believes that a healthy lifestyle and diet are critical for long-term health and for building our best hedge against many chronic diseases. So thank you, Katina.

Katina Thornton, MD:

[inaudible 00:06:22].

Dr. Julie Foucher:

All right. So lots of interesting people up here with great diverse backgrounds. We’re going to talk about wearables today. So let’s just start off with how did each of you start down this path of wearable tracking and what about it got you hooked? Whoever wants to start.

Katina Thornton, MD:

I’ll start. I’ll start because my journey with wearables started with a meeting with Josh. I was at a CrossFit Physician’s meeting and Josh was there. And so, I started wearing them and found out so much about how what I eat, sleep, drink affects my blood glucose and then how I feel in turn. And so, chance meetings can sometimes change your life.

Dr. Julie Foucher:

Wow! That is powerful. Yeah, go ahead.

Kristen Holmes:

Yeah, I’ll go next. I was coaching at Princeton University for about 13 years, and one of the things that I found early on, we were monitoring a ton of biomarkers during training. But what always perplexed me is that the load that my athletes were putting on in training didn’t predict next-day capacity. So we were using other technology to measure a capacity.

Kristen Holmes:

So there’s this disconnect between training load and next-day capacity. So I learned very quickly that it’s the other 20, 21, 22 hours that they’re not with me that has the most influence on capacity. That’s when I started going really deep down the rabbit hole of what can we measure in a 24/7 type of way.

Kristen Holmes:

That’s when I came across Whoop and was really … They were so far ahead in terms of data collections, so far ahead in their algorithms. They had hardware. So that’s when I became enamored and decided to join forces about five years ago. But yeah.

Nick Nwabueze, MD:

So that’s … I’m louder than I thought I was. So I think for me, things started with CrossFit. Like most people in CrossFit, we like login information and looking back over time and tracking data historically.

Nick Nwabueze, MD:

So seven or eight years into CrossFit training, about 2017-18, I was in residency, and I heard about this device, the Whoop and the data that it would reveal to you about yourself. Obviously, at this time, as all of us who have been through residency on this panel know, you’re sleep deprived a lot of time. You’re not going to be at peak performance.

Nick Nwabueze, MD:

Being able to quantify things and actually be able to see, okay, I’m in the red, which in residency happened to be a good about at the time. I’m in the red today. I can’t expect the best out of my body. I can’t expect peak performance with something that helped to calm down anxiety, or disappointment rather, when I wouldn’t perform as well as I thought I should be able to in the gym, because I’ve always been hard on myself.

Nick Nwabueze, MD:

Even if I’m coming off of a post-call shift at the hospital and I’m only running off at three-hour sleep, in my mind, I should still be able to del at 500 pounds. Why can’t I pick up this bar?

Nick Nwabueze, MD:

So looking at the Whoop and seeing that I’m in the red, it gave me permission to be a little more relaxed with myself. So, yeah, since then, I’ve used a bunch of wearables and a lot of technology, anyone who knows me knows I’m very nerdy. But, yeah, the Whoop was what started everything for me.

Mike Mallin, MD:

I’ll take it way back. I started wearing wearables when heart rate chest straps. Does anybody remember those, right?

Kristen Holmes:

Oh yes.

Mike Mallin, MD:

So I used to wear those at CrossFit, which got me a lot of weird looks for a while. My buddies and I used to have competitions to see who could get their heart rate the highest and keep it as high as possible for as long as possible. Not recommended.

Mike Mallin, MD:

Then at some point, I found out about Whoop. I think it was actually Whoop 1.0 that I started wearing and realized that I could start actually tracking recovery. That transition from performance to recovery is when it really hit for me and it really clicked, realizing that we can actually track that recovery, and that is then going to lead to performance down the road as opposed to actually tracking just performance.

Josh Clemente:

Yeah. So for me, it started at SpaceX. So I’ve been interested in human performance from a selfish perspective for a long time. I just wanted to be able to run fast and lift heavy things, but I had never thought deeply about nutrition and the holistic side of wellness. When I was at SpaceX, I was developing a life support system that required me to get exposure to the way NASA’s thinking about maintaining health over long durations when you don’t have access to medical care. It really started me thinking on what am I doing to ground my choices and data? Everything I do is based on emotion or what I saw someone else doing at the gym. There was nothing objective. At the same time, I’m in a very stressful part of my career and feeling burnout coming on quickly. I was having these fatigue episodes.

Josh Clemente:

I would have very, very … Like basically mood disorder. I would just be irritable. I would want to go home. I would want to crawl under my desk and sleep all these things that were strange to me and couldn’t be explained because I was in pretty good physical shape. I spoke to one of the doctors that was on the program with me and they recommended that I start tracking my blood sugar. So I got a finger prick device. I started pricking my finger obsessively and tracking it in an Excel spreadsheet. It wasn’t very useful to me. Then I read about CGM in Robb Wolf’s book actually, Wired to Eat, and that immediately changed things for me. So I went to my doctor, I asked for a CGM. I was promptly turned down and denied because I did not already have diabetes. The argument was that you need to worry about tracking blood sugar, if you have a blood sugar problem. But you do not. And so, therefore, you don’t need this.

Josh Clemente:

As a systems engineer, my thought process was, well, actually you track what you don’t want to fail. You don’t track it after it’s failed. That’s the way that you maintain systems. And so, I’m having energy system issues. Metabolism is the energy system. And so, glucose is the primary fuel. I should track this. So eventually I did get a CGM and I found out that I was prediabetic, and that’s when everything changed. So I completely transformed my lifestyle. Nutrition, exercise, sleep, stress, everything changed from one data stream. And so, I wanted build levels to be the whole process in one. So the actionability of the data, but also the accessibility of the devices. And so, that’s what we’re hoping to do is bring this to more people to make the technology, I think, what it can be eventually.

Dr. Julie Foucher:

That’s amazing, too. Just two points I want to highlight. One, I think it’s amazing that you found you were prediabetic when you were fit and in shape and how it really highlights how all these other factors would play a role, besides just exercise we’re doing. Like you said, it’s the sleep, it’s the stress, it’s all those other things, the 23 hours outside the gym.

Dr. Julie Foucher:

Then to Nick’s point about CrossFit has always been very much about tracking objective data, performance data. And so, now incorporating some other data points to inform those other aspects outside the gym.

Dr. Julie Foucher:

So there’s obviously a lot of things that we can track. You guys have mentioned blood glucose, the Whoop. I’d love to just dig into what are all the different metrics that you all have played around with and tracked and what do you find most useful that you use currently on a day-to-day basis?

Kristen Holmes:

Yeah, I think heart rate variability is a core metric to Whoop and I think one of the most important biomarkers that we can track, because I think it gives you a sense of not just physically how you’re adapting to external load, and this is life load, not just physiological load but psychological load as well. It’s a really powerful estimator of your psychological status. A lot of folks don’t actually realize that, but that will manifest in your autonomic nervous system, which HRV is a measure of.

Kristen Holmes:

So it just gives you, I think, just a really good snapshot of how you’re adapting to life’s stress. I think the opportunity with that is when you have insight into that and things aren’t going well, you can course-correct as opposed to, gosh, six months down the road, you’re still feeling like crap.

Kristen Holmes:

A few days of a downward trending HRV is an indication that, all right, I need to relook at my behaviors potentially. I need to rethink about the volume and intensity that I’m putting on my body, not just physically but psychologically as well. So it just gives you a really good snapshot of just how you’re trending and how you’re adapting to external stress.

Mike Mallin, MD:

I’ll definitely agree with the HRV. I think that one’s huge. I also use resting heart rate in conjunction with HRV in terms of overall stress response and recovery. I will take a slightly different lean on HRV, though, and that’s towards the constant measuring of it.

Mike Mallin, MD:

I don’t know if you guys have heard of the Lief device. There’s a couple others out there. But it basically measures your HRV continuously. It’s like a device that goes on your chest. It measures your HRV and it zaps you, vibrates, whenever your HRV drops. It takes you through a series of breaths to bring your HRV back up.

Mike Mallin, MD:

When you wear this device, it becomes really apparent very quickly how much we go up and down with the stress response throughout the day. Personally, I noticed whenever I started to do email, I would have what’s called email apnea, where I basically sit there and I’m starting to type an email. I don’t breathe as I’m typing the email. Then after I hit send, I let out a big sign.

Mike Mallin, MD:

When that happens, you’re creating stress within your body. You’re activating the sympathetic nervous system. You mentioned the sympathetic/autonomic nervous system. HRV’s a measure of the balance between the sympathetic and the parasympathetic nervous system, sympathetic being cortisol, stress, parasympathetic being relaxation, less stress.

Mike Mallin, MD:

So what you’re doing by measuring your HRV constantly like that is you’re teaching yourself to realize when you’re allowing stress to get the better of you. By going through these little breathing exercises throughout the day, you can start to activate the parasympathetic nervous system during times of the day when you wouldn’t normally do it and improve your overall recovery over time. So for me, that was a huge one that I think everybody should try out. No affiliation.

Nick Nwabueze, MD:

So I can remark on two. I would definitely agree with you with HRV and then you with resting heart rate. I think resting heart rate is huge for telling you I’ve noticed a correlation with that in just how well I slept.

Nick Nwabueze, MD:

So I’m from Denver, where we live a mile high. Because of that, I’ve noticed just in the couple days that I’m here that my resting heart rate is now in the mid 40s to low 40s. It’s almost like my body’s like, “Oh, you don’t have to work as hard to supply your body with oxygen.” So looking at that, trending out over time is very important.

Nick Nwabueze, MD:

I think one thing that she did remark on with a Whoop that is very important in this post-COVID time is that you could essentially use it to essentially figure out when you may be coming down with an infection. I did have COVID early last year, and I knew it before it happened because my respiratory rate was very high before I was diagnosed with it. Then as things got better, my respiratory rate trended down towards normal.

Nick Nwabueze, MD:

Outside of Whoop, I would say with Levels and continuous glucose monitoring, you’re able to see the correlation between the foods that you eat, which unbeknownst to you may not be as healthy as you think that they are. I’m not going to name any names of any products, I don’t want to slander anybody, but there are a lot of products that are marketed that you eat them and you look at your blood sugar, and there can be a good amount of glycemic variability secondary to eating a protein bar that you’re like, “Oh, this is healthy.”

Nick Nwabueze, MD:

Okay, no, I’m going to absolutely slander one brand here. Gatorade. So Gatorade made these delicious protein bars that taste like Snickers. They’re like, oh, high protein, 30-something grams. I would encourage you to eat that and track what happens with Levels with your sugar. You will notice a very big spike.

Nick Nwabueze, MD:

That’s because along with that protein is a healthy dose of high-glycemic index sugar, usually high-fructose corn syrup. You’re not really going to be able to have that revelation unless you can monitor your glucose in real time.

Nick Nwabueze, MD:

With Levels, one thing that I very much like is the software. The software is essentially able to assign glucose variability that is due to one food to whatever you ate, as opposed to like you could eat a couple different things and it’ll still be able to tell you, okay, your blood sugar rose because of this specific thing. It will actually assign scores to your food. So, yeah, that’s Whoop and that’s Levels. Yeah, hopefully that’s a good answer.

Katina Thornton, MD:

So I’m going to echo what you all have said, but take it one step further. The one thing that I love about the CrossFit community is that people are interested in their health and they enjoy tracking.

Katina Thornton, MD:

What I found is that I can take the data that I found on myself and extrapolate it to members of our community. And so, for example, at this competition, I’ve been at the medical table and we’ve had athletes come in for various reasons, whether they think they’re getting sick or they’re exhausted from a workout.

Katina Thornton, MD:

And so many of them are wearing a CGM or have a loop on their wrist. I can take their cellphone and look at their data and have a feel for what is going on with these athletes or spectators or volunteers. And so, by myself having tracked data and seeing what happened when I was under stress, or I didn’t have enough sleep, or I wasn’t eating right, or I was getting sick, I can use that and help make a decision about how we’re going to treat these people moving forward.

Katina Thornton, MD:

And so, what’s wonderful is that as we have the community use these devices and learn about themselves, they’ll be able to preempt these issues on their own. But until they do, I think that we’ve all found that we can help them with the knowledge that we’ve gained from biohacking ourselves.

Mike Mallin, MD:

Just to echo on that real quick, because that was a great point that you made, I think all of us assign a certain amount of recovery needed to each workout. If you go and you do a really hard, long session, a long, hard chipper, and you go all out, you’re going to assign a great deal of recovery to that.

Mike Mallin, MD:

But I think what we forget to do a lot of the time is to assign recovery to other aspects of our life. Maybe your job’s a bit busier or you’ve got stuff going on at home, or you’ve been traveling so you haven’t been sleeping as much. The objective data that we’re collecting with these devices allows us to actually start to do that a little bit, and to realize that recovery is required for more than just one place. It’s not just exercise that needs to recover. It’s also stress. It’s also lack of sleep. It’s also poor diet nutrition, all of those things. That’s what these devices are allowing us to start to do is pull all that information in together.

Josh Clemente:

Yeah. I mean for me, I’m going to continue the trend here, but cardiovascular-

Kristen Holmes:

You should hire all these people.

Josh Clemente:

Right. Cardiovascular health and I think metabolic health, and I consider metabolic fitness and the way that I’m generating energy to be core and the foundation under which physical health and mental health are built. All the tissues in our bodies need to be able to generate energy efficiently to operate efficiently. So if you can’t do that, you can’t be peak physical fit, peak mental fit. And so, I start there. I start with what am I putting in my body and why and having objective data that drives those decisions and is contextual. The most important thing is that we look at the glycemic index and it’s an average of averages normalized to a hundred. How do you know what to eat for lunch after you’ve had a red-eye flight? Because it’s going to be different than what to have for lunch when you’re well-rested and have been training for multiple weeks, effectively. And so, it’s that context dependency that I think is most important, and anything that you can use … For me, it’s CGM, heart rate and heart rate variability through Whoop … to keep you in the know with continuous closed feedback loops, I think, is … That’s what it’s all about.

Nick Nwabueze, MD:

Do you want to touch on how a response is different between different people for the same foods? So I think a lot of people aren’t aware of that.

Josh Clemente:

Yeah, sure. One of the most interesting studies that really confirmed my goals with the company when starting it was I read about this Weitzman Institute trial. It was in 2015 in Israel. They took 800 people without diabetes and put CGMs on them, and then tracked what happened over the course of seven days. They gave out these standard meals. So everyone ate the same foods. Then they were able to later look at that dataset. They showed that two people in this dataset could eat the exact same two foods … In this case, it was a cookie made with wheat flour and a banana … and they could have equal and opposite blood sugar responses. So a big spike from the banana, flat from the cookie for one person and the exact opposite for the other.

Josh Clemente:

The implication there is that the hormones that respond to the foods we’re eating, the macronutrients that are breaking down into our blood, could also be equal and opposite. So one person’s experiencing a big influx of insulin, which could be causing anything from inflammation to weight gain, to cognitive cloudiness. These are all the sorts of qualitative experiences, and to each their own in terms of what they’re focused on. But if this is truly happening, the hormones downstream could be totally opposite for two of us. That’s where the personalization element comes in. There’s been follow on studies that have demonstrated the same effect. I can just say for a fact we have a very large dataset now and it is showing the exact same thing. There’s a massive disparity among people, in terms of what they eat and how it affects them.

Mike Mallin, MD:

I feel like we need a hater. I’m just going to start. I’m going to hate on wearables for the rest of the panel. We need a hater. Sorry.

Kristen Holmes:

Can I add a point to Mike? Because I think people are really interested in protocols and what behaviors they can deploy. You mentioned real-time heart rate variability. That is something that we track. We don’t surface it to users because it’s really noisy.

Kristen Holmes:

But one of my responsibilities at Whoop is basically to ensure that all the claims that we’re making are grounded in super rigorous science. That drives a lot of the research that we do at Whoop.

Kristen Holmes:

One of the things that we just finished, some research with Stanford University, the principal investigator was Dr. Andrew Huberman, who you probably know. But we were able to actually … This is super novel research. You guys are the first people to hear it. But we were able to come up, we were able to see in the data what breathing protocol actually activates the parasympathetic branch the most and actually has the most influence on sleep architecture.

Kristen Holmes:

What we found is that the physiological sigh, which is a double inhale, long exhale, is the most efficacious in reducing real in-the-moment stress. So, as Mike pointed out, as you go through the day, you don’t want to be in a situation where you’re not taking these many moments of rest, because it does accumulate. It is going to influence your sleep onset latency. It is going to influence the time you’re spending in these deeper stages of sleep. And it will influence your capacity to recover the next day.

Kristen Holmes:

So it’s so powerful to build in these physiological sighs. Five to 10 cycles three or four times a day will have an enormous impact on mitigating these low levels of chronic stress.

Dr. Julie Foucher:

I love that. Kristen, I think you should lead us all in a breathing-

Kristen Holmes:

[inaudible 00:26:12]. All through the nose, if you can. Nasal breathing, folks. Just breathe. Not breathe through the mouths.

Dr. Julie Foucher:

All right. So CrossFit has also always been really big on using our performance data to drive these N of one experiments and doing really individualized experiments so that we know what is going to improve our training. So whether it’s changing something about your training or recovery and tracking your workouts and trying to always see improvement, but now we have all these other data points that we can use.

Dr. Julie Foucher:

And so, I’m interested to hear from all of you if you could each maybe touch on one N of one experiment that you’ve tried on yourself that maybe was the most surprising or that you learned the most from. Mike?

Nick Nwabueze, MD:

[inaudible 00:26:53].

Mike Mallin, MD:

I don’t know. Blood sugar for me. So the first time I got a CGM, I put it on. Over the course of about a week, I ate the exact same thing at the exact same time of day and just altered slight things about what I ate. So it was a banana. With that banana, the first day, it was just a banana by itself. Then the next day, it was a banana with some eggs. The next day, it was a banana with some broccoli. Then the next day, it was a walk followed by a banana. Then the following day, it was a banana followed by a walk.

Mike Mallin, MD:

It blew my mind how different that glucose response is with just that little augmentation of either adding a little protein, adding a little fat, adding some fiber, or movement around actually ingesting that food. It actually changed the way that I eat still.

Mike Mallin, MD:

I mean I grew up eating oatmeal. I ate oatmeal my entire life basically until about two years ago when I wore a CGM and I realized that my blood sugar was spiking into 175 when I ate oatmeal. It didn’t matter if it had protein or almond butter or whatever in it. It was terrible. It was a bad response. So putting in oatmeal, and I’ve changed multiple other aspects of my diet.

Mike Mallin, MD:

I feel like CGM is one of those things. I tell my patients this all the time. They ask me, “Doc, should I get a CGM?” and my answer is always yes. I don’t think I’ve ever said no to anyone because even if you are so in tune with your body, even if you’re a professional athlete or you’re even a nutritionist, you don’t know how you’re going to respond to food until you know. So actually seeing that data real and live over the course of a couple of weeks can completely change the way that you approach food.

Josh Clemente:

Sounds familiar.

Dr. Julie Foucher:

You did the exact same experiment with a banana?

Josh Clemente:

Basically. I don’t think I was as rigorous. The protein in fat, the walk, and walk order, those were the two things that I did. That’s basically what I run through with every food that I now eat, is I’ve run a couple different variations to see what has the most effect for a certain food and I compare them directly to each other. Then that’s how I eat that food going forward. It sounds like a lot of cognitive overhead, but actually it’s really easy. You don’t forget these things. If you’re tracking it, you’ve got it to refer back to.

Josh Clemente:

It’s funny you bring up oatmeal as well because in our dataset, the number one offender for postprandial, post-meal elevations is oatmeal. A lot of people who … Cardiovascular disease is very closely related, as you all know, to inflammation, which is also well-correlated with blood sugar variability. And so, people who are trying to avoid heart disease are potentially … Or even already have cardiovascular disease are oftentimes referred to the heart healthy oatmeal as a morning breakfast option. If you Google the healthiest options for breakfast, oatmeal’s up there on all of them no matter where you find it. It turns out that a lot of these people likely are doing damage as opposed to serving their own goals.

Katina Thornton, MD:

So I’m going to relate my N of one experiment to the CGM. When I was pregnant with one of my children, this was before I ever wore a CGM, I went in for my fasting glucose, and it was high, high enough that they wanted to do further testing. I said, “No, no, there must be some mistake. I exercise all the time. I’ve read that it can increase your blood sugar.” “No, no, no, no. We have to do the test.” So we did and it was normal. I never really thought much about it again until I had a CGM and I was wearing it.

Katina Thornton, MD:

Because of my work, I don’t eat during the day. So I wake up and I’m fasted until I get home from work, or I go to the gym. And so, I had the CGM on and I would go from work to the gym and do whatever the workout of the day was. I constantly had my phone checking my blood sugar. I wanted to see what it did, not really understanding that I could see the trend five hours later or six hours later.

Katina Thornton, MD:

Every intense workout, think fran, my blood sugar would spike to 150, sometimes 200. I thought back and I realized that I went and had my fasting glucose after I had worked out. And so, it made sense to me after seeing the data that my blood sugar would be elevated.

Katina Thornton, MD:

The other thing that I realized is maybe there’s no need for carb loading before you work out when your body is able to produce that response all on its own. And so, it turned on its head all of the thoughts that I had about how you should eat to train.

Katina Thornton, MD:

Then combining that with the Whoop and looking at recovery and the heart rate variability, I realized that there’s a lot of interplay physiologically between your blood sugar and your heart rate. I’m thinking that you need to tell them how heart rate variability declines with age-

Kristen Holmes:

Oh, yeah.

Katina Thornton, MD:

… and your number is so far out the roof.

Kristen Holmes:

Yeah. I’m in my 40s. So, yeah, to have, I think, metrics, which relative to my age group, I’m in the very top 0.001% of that group. A lot of it is obviously I’m dialed in on a ton of stuff. I measure my glucose and I’m really cognizant of the type of exercise that I deploy.

Kristen Holmes:

I’m a scientist, I’m thinking about these things pretty intently. There’s a taxonomy of breathing protocols. I do the ones that are most efficacious. So about applying my efforts, I’m really specific.

Kristen Holmes:

So there’s a lot of factors, but I think the evidence at this point is indisputable that sleep-wake timing is the core behavior that really does translate to preventing aging, frankly. I just think you literally delay your clock if you stabilize your sleep-wake timing.

Dr. Julie Foucher:

Can you just talk about how you do that from a practical standpoint? Like-

Kristen Holmes:

Yeah, I have no social life. I’m just kidding. Yeah. I mean I just set boundaries with the people I love. I know that I can’t show up and be available and be engaged and present in the way that I want to if I don’t adhere to this behavior. So I go early, like I’m with the senior citizens at 5:00 for dinner. Yeah, baby.

Kristen Holmes:

So, yeah, I mean I tell my friends this is how I roll. I mean everyone’s cool with it, but, yeah, I mean I start my pre-bed routine at like 8:45. I’m asleep by 9:45. I do reading, gratitude journal. That time has become really sacred for me. I just feel way more stable than I’ve ever felt in my entire life, way more productive. I mean I feel like I can take on a ton over the course of the day. I think I really attributed to this sleep-wake timing.

Nick Nwabueze, MD:

And you’re setting an alarm to wake up every morning.

Kristen Holmes:

I wake up naturally, so I don’t even need to set an alarm. I wake up basically 5:45 on the dot every single day. Yeah.

Mike Mallin, MD:

What you just said, the journaling, the gratitude journal, the reading, the time before bed, getting in bed, having a routine before bed is 100% the most important that I’ve seen in my patients in terms of improving sleep.

Kristen Holmes:

Yeah. No question.

Mike Mallin, MD:

[crosstalk 00:34:02].

Kristen Holmes:

Cold and quiet is obviously really important to your environment, but yeah.

Nick Nwabueze, MD:

I’ve noticed patients … So not just mindfulness meditation, all forms of mindfulness help people raise both their recovery, their HRV decrease, their resting heart rate. Going back to Julie’s question from earlier, my N of one experiment, I went just insane.

Nick Nwabueze, MD:

So there’s a PNOĒ metabolic device. Many of you have probably seen this. So I strapped myself onto one of those. I found an assault bike at the gym and, over the next 17 minutes, I subjected myself to torture.

Nick Nwabueze, MD:

But it was really cool. At the end of it, I basically was presented with graphical data essentially telling me that what I had been doing for the last three years wasn’t that it was ineffective. It was that it was suboptimal. What I had been doing was I was very low carb at all times.

Nick Nwabueze, MD:

I will never knock anything low carb. It works for a lot of people. But I think that when you’re trying to output 100% at the gym and you have these certain demands of yourself, that eating around your exercise is more ideal.

Nick Nwabueze, MD:

So, essentially, the PNOĒ demonstrated to me that at an average heart rate that I found from my Whoop that I tend to maintain during workouts, which my average heart rate will usually be at about 170, according to the PNOĒ, I’m burning 20 calories per minute at that heart rate. And, furthermore, given what’s called the RER, the respiratory exchange ratio, I’m burning no fat at that moment. It is all carbs in the event of because I’m low carb at that moment.

Nick Nwabueze, MD:

So there are things in the human body called gluconeogenesis and glycogenolysis. Essentially, even when you’re low carb, your body can still produce sugar. My issue with that, and using it for peak performance and CrossFit, is that it lags. At least in my opinion, it’s not quick enough to give you the energy that you need.

Nick Nwabueze, MD:

So long story short, given that data that I got from the PNOĒ, I then turned around and used this man’s device, the Levels, to determine, okay, if I make a shake with berries and a little bit of honey and blah, blah, blah, how long will it take to get my blood sugar at a level that I can go hit a workout and I will know that I have sugar available for my muscles? That time was about 40 to 50 minutes.

Nick Nwabueze, MD:

So as you can imagine, what I started doing was immediately, 40 to 50 minutes before the workout, I would make a relatively … Not super high carb, maybe 50 to 60 grams of carbohydrates protein shake. I would drink that and I would go hit a workout. I cannot tell you the difference in how I felt. I felt so much better during workouts. I felt like I could just keep doing work and I could keep breathing.

Nick Nwabueze, MD:

It all went back to, number one, being able to see the shake that I made, exactly what the glycemic trend would be, what the response would be with my body. Then obviously before that, using the metabolic device to determine that during very high heart rates of CrossFit, I am not burning fat.

Nick Nwabueze, MD:

This isn’t just for CrossFit. Actually, any high-intensity interval training exercise burns primarily carbohydrates. Afterward, after the workout, hours after, yes, you do then default into more fat burning, but during CrossFit, you’re burning carbs. So using a combination of devices, I basically figured out exactly how many carbs I need, so I don’t need to overeat and I certainly don’t need to undereat.

Kristen Holmes:

We do have a partnership with PNOĒ. So if you have that cardio metabolic data, you can send it to our membership services and they can calibrate your data based on … I know, I know.

Nick Nwabueze, MD:

[inaudible 00:37:55].

Kristen Holmes:

I know. I know. So anyone who does PNOĒ, you can get your BMR set and it would be more accurate.

Dr. Julie Foucher:

Wow. I’m learning so much. This is so great. All right, let’s take some questions from the audience. We’ve got about 10 more minutes. All right, Noah’s coming with the microphone.

Speaker 7:

Hi. Is this on? Yeah. Spencer with BarBend. Thank you all so much. This was enormously helpful, but I think it was a little esoteric and a little bit inaccessible, especially for people without a certain level of affluence. So in terms of actionability, are there things you would recommend for people who aren’t able to biohack to the degree that you all are?

Kristen Holmes:

Such a good question.

Josh Clemente:

I’m just going to throw out there that one of the most impressive effects that I’ve seen that anyone can replicate today is light movement after meals. So if there’s one thing I would say, start today, it’s after you finish dinner, put the dishes in the sink and go for a walk around the neighborhood. It’s dramatically different, but consistent across the population how much this can improve the glycemic response of that meal. It’s just your posterior chain, big muscles pulling glucose right out of your blood as you’re moving. It’s something that holds for everyone. It’s simple and it’s great. It’s good for your mind, it’s good for your body, and it’s easy to do.

Nick Nwabueze, MD:

And to add to Josh, in addition to doing that, we were all told as children by our parents, “Don’t eat your dessert first.” Eat the main meal. With Levels you’re able … And even if you don’t have Levels, I’m telling you that you’re able to see that your parents were 100% right. Eating your protein, eating your fiber before eating your, I don’t know, chocolate chip skillet or ice cream is a lot better when it comes to the glycemic response. It essentially will blunt their response afterward, very much so walking. Walking will do essentially the same. But, yeah, those are two things anyone should be able to do.

Katina Thornton, MD:

Something else that I think should be added is that no matter what it is that you’re eating, if it’s a whole food rather than a processed food is going to be better 100% of the time. So when you’re making your food choices, if you’re opening a package, it’s not going to be as good as if you’re eating a salad or a vegetable or a whole fruit. And so, that’s probably the easiest thing to do. You don’t really have to think much about other than the source of what you’re eating, where it’s coming from, and who made it, Mother Nature or a company.

Mike Mallin, MD:

I think … Yes. You’re loud. You’re loud. I think it could be as simple as what gets measured gets managed. So if you want to actually manage your sleep, if you want to manage your glucose response to food and your metabolic intake, then measure it. I don’t think it has to be any more esoteric or complicated than that. I think literally just putting that device on your body and every once in a while pulling your phone out and looking to see what it’s telling you, you’re going to learn 80% to 90% of what we just told you up here within a matter of weeks. That’s the cool part is that it’s really that easy.

Kristen Holmes:

I think for folks who can’t afford devices, probably the best thing that you can do is breathe through your nose. I think we should be teaching this to children as soon as they come out of the womb. I think we see there’s quite a strong correlation between if you’re sleeping with your mouth open, if you’re breathing with your mouth open primarily during the day, really your mouth is for talking and eating, and that’s it. I’m sorry, I almost went down a really dark path there. But it’s for eating and talking. And so, we should prioritize breathing through our nose, and that is free.

Kristen Holmes:

So there needs to be just way more education at lower level, in school, to make sure that children are becoming aware of this and mindful. They should be practicing it in the same way they practice Math and English and Science. There’s a lot of really good resources. We need to evangelize, spread the word.

Dr. Julie Foucher:

I would just add that there are more low-tech ways to measure, too. So even if you’re not purchasing a Whoop or a Levels device, maybe you just have, like Josh start out, finger stick and prick your glucose. Maybe you just measure more subjectively. How do I feel before and after I eat and rate it on a number scale and keep an Excel spreadsheet, like many of you probably did when you started tracking. There are different ways to measure that are less expensive and accessible,

Nick Nwabueze, MD:

Or even just checking your resting heart rate in bed in the morning before you roll out. There are so many simple things we could do.

Kristen Holmes:

The BOLT test for recovery. It’s really good, too. Just look it up.

Mike Mallin, MD:

[inaudible 00:42:59].

Kristen Holmes:

Grip strength is also another proxy for recovery. The Canadians love the grip. That’s a whole bunch of Canadian research on grip strength and its correlation to performance and recovery. So you can look that up.

Nick Nwabueze, MD:

[inaudible 00:43:14].

Dr. Julie Foucher:

Love it. All right, let’s take another question from the audience. No, over here.

Male:

Okay.

Speaker 9:

Okay. I have a … Whoa. I have a question about HRV. So I track my HRV, sleeping HRV, but I don’t actually know what I’m looking for. I know very fit people that are my age who have HRVs in 200s and mine’s like 140. Then I have someone else who has one in the 60s. Is the baseline more important in tracking change, or are we all striving for a certain goal?

Josh Clemente:

Yeah, I think across the board for any tracking, it’s all N of one. I think this is the beauty of wearables generally is that they’re allowing us to create population scale N of one experiments, which all stack up to changes across society. But the individual should focus on their patterns and trends. Comparing absolute numbers baseline-to-baseline is not really helpful for you. You can’t magically change it, but you can see what is within your control to improve. Obviously, I don’t know enough about HRV, but I do see this across the board, that people tend to compare on the absolute values and get too fixed on them. Anyone in wearables, in the wearable industry and bringing this stuff out should help others recognize that it’s the patterns and trends that you can influence.

Katina Thornton, MD:

It might be similar to asking somebody what their weight is. If they weigh less than you, then you get worried. If they weigh more than you, then you’re like, “Oh, wow.” It’s a similar situation because everybody is so different.

Dr. Julie Foucher:

One more question. We have a … Yeah.

Speaker 10:

Hi. So going off of her question, offhand, are there specific, I guess, conditions that would affect having a much lower baseline in HRV? So reference, the highest I’ve ever gotten mine is maybe like 46, 50. But it’s always been my norm to have that like 20 to 45 range. So wondering if there’s other … Because I have a couple medical conditions and I don’t know what affects them.

Kristen Holmes:

Medication is, I think, important to … That can artificially change your heart rate variability. So, Mike, you probably talked from this medical perspective, or Nick or Katina, but there’s lots of things that can artificially change it that would make your baseline be not as accurate.

Nick Nwabueze, MD:

So thyroid issues could definitely do it. I think that HRV is one of those things that … At least when it comes to the large consortium of medical diagnoses, it’s not like in med school we’re taught this condition’s going to affect your heart rate variability. Now-

Dr. Julie Foucher:

What is heart rate variability? Did you learn that in med school?

Nick Nwabueze, MD:

I know, right? Yeah. I don’t think I heard it once in med school. So that speaks to something Julie’s implying and I’m implying, too. A lot of this is self-taught. I remember it must have been a year ago. Whoop actually sent out an email saying everything there is to know about HRV. That’s where I found the age correlation with HRV and essentially stopped comparing my HRV to other people’s and just figured out my baseline.

Nick Nwabueze, MD:

So I think that as long as you know your baseline and you’re trying to stay towards the upper end of that, I think things are fine. I don’t think it’s important to try and fixate on raising it further beyond the things that we’ve already talked about, making sure that you’re resting heart rate is as low as you can have it, your recovery score is good. You try to activate your parasympathetic tone, your parasympathetic nervous system, as much as possible as opposed to your sympathetic. Those are the things that I would fixate on as opposed to the minutia of trying to get your HRV as high as possible.

Mike Mallin, MD:

Just to say it out loud, 40’s not weird. That’s totally cool. You’re doing great.

Katina Thornton, MD:

Now I wonder what Dr. Mallin’s is.

Mike Mallin, MD:

What’s yours?

Katina Thornton, MD:

It started out at 40 and I was really worried about it. Now it’s at 80. It took about eight months of mindful attention to get it there, and I’m hoping to continue to get it higher.

Mike Mallin, MD:

I will say one thing. Mine actually depends on which device I’m wearing. So it’s way different on Whoop than it is on Oura. So that’s another thing to think about as well is you’re actually going to get … I get a much higher number on Whoop than I do on Oura.

Kristen Holmes:

Yeah. It’s because we filter ectopic beats, just so you know.

Mike Mallin, MD:

Yeah. Oura just averages out throughout the entire night.

Kristen Holmes:

So as far as more, ours is more accurate.

Katina Thornton, MD:

Do you have a lot of ectopy?

Nick Nwabueze, MD:

Doesn’t Whoop measure it within the last five minutes-

Kristen Holmes:

Hoping to get that in.

Nick Nwabueze, MD:

… of short rate?

Dr. Julie Foucher:

All right. All right. All right.

Kristen Holmes:

I’m just kidding.

Dr. Julie Foucher:

All right. Let’s take one more question and then we’ll wrap this up.

Kelsey:

Hey, my name is Kelsey. I had a quick question about wearing wearable devices with night shift work. So most ones that I’ve been acquainted with, I don’t … Not super familiar with CGM, but they reset during the night. I do think for myself and a lot of people in the same category, wearable devices would be very beneficial in trying to just hold on on what little health we can while being dysregulated. So I didn’t know if you guys had any advice on what to utilize or if there are resources out there.

Mike Mallin, MD:

I’ll take this one because I work night shifts, or I used to. I used to work in the emergency room and I’d work overnight shifts. One of the most frustrating things for me would be I would work a night shift and then I’d go home and I’d sleep for a solid six or seven hours. Then I’d wake up and my Oura Ring or my Whoop didn’t quite pick it up. I’d get dings and now my recovery score sucks. It takes me three days to work it back up. It used to drive me insane.

Mike Mallin, MD:

I don’t have a solution, but I feel your pain. I just wanted to say thank you for saying that. Somebody needs to scream that over in this direction over here, so that we’d get-

Kristen Holmes:

Yeah, actually-

Mike Mallin, MD:

Maybe they’re still working on it. But-

Kristen Holmes:

Well, yeah, that’s another issue. You can always edit your sleep. We go back in and we’ll look at it. So that’s a way to think about it. But I think in terms of behaviorally, things that you can do, we’re actually doing research with the US Army. One of the most important influencers on our circadian rhythm is obviously how we’re interacting with light, artificial light and natural light. That actually is emerging in the study of a thousand … With the US Army Alaska as one of the predictors of resilience.

Kristen Holmes:

So we understand at a fundamental level that our circadian rhythm obviously is really important, and as a night shift worker, you’re experiencing massive amounts of desynchronization in that area. So if you think about it from a perspective of what are the anchors that you can grasp onto that help regulate the system in spite of not being able to be awake during the day, and that is exercise, it is meal timing, and it is light exposure.

Kristen Holmes:

So if you go onto the night shift and you’re coming home, you want to try to minimize as much light exposure as possible so your body then starts to anticipate it’s time to sleep. So wear blocking glasses in the morning on your way home. Wear sunglasses, everything you do to minimize that light on the way home.

Kristen Holmes:

Then once you get home, you want to try to go to bed as soon as humanly possible. That is when your pressure for sleep will be at its highest. So you want to go to bed and you want to try to get a consolidated seven hours, if you can. Wake up. If you’re a morning person, exercise. That’s another cue that your body will work off of.

Kristen Holmes:

Then try to eat at regular times during your shift. Do not snack. That is where you confuse [inaudible 00:51:09] out of your system. So do not snack. If you fast, fast as you normally would. If that’s part of your protocol, do that as you normally would. Then just really try to repeat that as often as possible.

Kristen Holmes:

But again, even though you’re not awake during the day, stabilizing that sleep-wake time is really, really important. Again, regulate as much as you can in spite of not having that light exposure.

Josh Clemente:

One other thing I’ll throw in there is that temperature plays into a lot of this stuff and it can be tricky. It’s like cooler when you’re awake and warmer when you’re trying to sleep. I think room temperature when you’re trying to sleep is critical. I use a cooling product for sleeping. It’s called Eight Sleep, which is awesome. But anything that you can do to lower the temperature of your bed or your sleeping area I think will also help get you that full seven, eight hours.

Kristen Holmes:

Yeah. Cool, dark, quiet.

Josh Clemente:

Yeah.

Dr. Julie Foucher:

Amazing. Well, we are out of time, guys. But thank you so much for coming. A huge round of applause for all of our panelists. This was awesome.

Dr. Julie Foucher:

Thanks so much for tuning in. If you enjoy listening to the podcast, please consider subscribing and giving it a five-star rating on iTunes. It really does help to get the word out to more people.