#30: Using Biometrics to Manage Long COVID, with Visible CEO Harry Leeming

Summary

In this conversation, Dr Zeest Khan and Visible founder Harry Leeming discuss the innovative use of biometric tracking in managing long COVID and other chronic illnesses. They explore the significance of heart rate variability (HRV), the role of wearable technology, and the importance of pacing in symptom management. The discussion also highlights the impact of the menstrual cycle on health and the resources available through Visible, a company dedicated to improving health outcomes for those with chronic conditions.

MakeVisible.com

Chapters

• 0:00 Introduction
• 2:36 Harry's Journey With Long COVID
• 5:12 The Birth of Visible
• 8:39 Tracking Symptoms and Data
• 10:49 Understanding Pacing and Management
• 12:11 Physiology of Crashes
• 15:23 Heart Rate Variability Explained
• 26:47 Biometrics role in Long COVID
• 28:34 Menstrual Cycle and Long COVID
• 35:33 Closing Thoughts and Resources

Transcript

Zeest Khan (00:00)
Hi, I'm Dr. Zeest Khan, the Long COVID MD. I'm a physician with long COVID and I've applied all of my medical expertise to my recovery. Luckily, it's working and I want to share what I've learned with you. On this podcast, I help you understand your body and understand the healthcare system so you can move your own health forward.

We've got a lot to talk about, but remember, nothing I say here replaces personalized medical advice from your healthcare team. Let's get started.

Zeest Khan (00:36)
Today I talk with Harry Leeming, the founder and CEO of Visible. Visible is a biometric tracking device designed for people with long COVID and other fatiguing illnesses.

Visible launched its free app in October, 2022, where you can track your symptoms and measure your heart rate variability. Harry will explain what heart rate variability is in our conversation.

A year after they launched the app, Visible introduced a wearable that measures biometric data more accurately. What I like about Visible is that it uses this data differently than other wearables like Apple Watch or Fitbit.

Those devices encourage you to exert yourself or to push yourself more. Visible uses the data to help prevent you from over-exerting yourself. The goal is not to break a personal record in the gym,

but to help prevent a long COVID crash. A lot of us use Biotrackers. Visible uses it pretty innovatively. so I invited Harry on to Long COVID MD to explain what Biotrackers are and how we can use them to improve our health. In our conversation, he explains the difference between resting heart rate and heart rate variability.

We talk about the ways the menstrual cycle affects long COVID, how visible is contributing to long COVID research, and the best ways to use biometric data no matter what device you use. Without further ado, here's my conversation with Harry Leeming.

Zeest Khan (02:13)
Harry, thank you so much for joining me. I am really excited to talk about Visible. Your career revolves around long COVID and fatiguing diseases. But can you tell us a little bit about you and your life before the pandemic started? What were you doing and what were your career goals then?

Harry Leeming (02:36)
Sure, so I probably have quite a similar story to a lot of people. was in my 20s, I was fit, healthy, hadn't really been to see doctors ever really in my life. was just cracking on with my career. I was working in tech. I was also before that working as an engineer, briefly worked in Formula One for a while.

was living an exciting, exciting life and then got COVID in the second wave of the pandemic. And to this day now, I'm still struggling with symptoms from that.

Zeest Khan (03:16)
How did you discover that you had long COVID?

Harry Leeming (03:22)
so I, I had sort of two weeks of feeling, quite sick. was pretty under the weather with that first infection. Then I was back at work within a couple of days thinking everything was fine. And then my body had what felt like was a meltdown with my heart racing. This is what felt like massive fluctuations in my blood pressure.

what I now know is autonomic nervous system dysfunction. And it was quite scary. I wasn't really able to leave the house. I was really struggling to stand and spent the next couple of weeks, even months housebound. I'm fortunate that since then I've got...

a lot of my health back, not all of it, but enough to be able to work on visible. And, you know, I sometimes joke that like I'm well enough to be able to work on visible, but I'm still sick enough to know just how serious and debilitating these conditions are. And I'm extremely motivated to try and help find a solution.

Zeest Khan (04:30)
Yeah, so tell us more about that motivation. When was it that it clicked in your head that you're like, I need, we need this and I'm going to go try to make it. What is visible?

Harry Leeming (04:44)
Sure, so Visible is a company that we start to use wearable technology to help measure and manage complex chronic illnesses, and including that long COVID, but also ME-CFS, fibromyalgia, EDS, these other conditions with very similar overlapping symptoms. how we landed there was...

You know, I had a similar journey to most where you're going between all these doctors and you're getting your blood tests and you're being told this is in your head. There's nothing really wrong with you. And I, you know, deep down, I was like, this doesn't feel right. There really is something going on here. And so sort of left on my own to figure out my own health journey. I started to look for a fitness tracker because I wanted to be motivated in the next couple of months, knowing this was going to be probably a long journey.

that I could see some improvement in my step count or in my activity and that I was on the right trajectory to getting back to where I was. But actually in that first sort of Google for a fitness tracker, everything that was available to me that I could find was had pictures of people going for runs or doing workouts and everything was around pushing yourself and doing more. Nothing really spoke to me as someone with symptoms who was housebound.

who like no more than ever did I need to track my health. You know, I used to be a runner, you I used to go to the gym and I didn't need these devices before, but now I really did and none of them were designed for me and I could tell that by just looking at the, you know, their websites, the packaging they come in and the names, you know, Fitbit has the word fit in the title. And so even then from that first, you know, that was probably month one or two and back of my mind, I was like, I can't believe something doesn't

exist here for people in my situation.

And then fast track, you know, a couple of weeks later and these tests are coming back saying there's nothing wrong with me. I'm in the normal range for everything, but actually I can see through my wearable data that what's happening in my body was not normal. What's happening with my biometrics, my heart rate was all over the place. That there was some very clear signals here that there was something not right. And actually I use that to help get my diagnosis for long COVID. So now, you know, not only found that there is not nothing designed for people, people from a

messaging standpoint, but also there's this power within wearable data to be able to potentially use it as a diagnostic. And then fast forward another couple of weeks, I'm trying to exercise my way out of it, back in these early days where that felt like the only solution on what we were all told to do. And I was pushing myself and I realized as I was looking at my data, actually I was making myself worse. And so I was having to do the mental gymnastics or using my fitness tracker to teach myself to do

less, not do more. And so I guess at every stage in that journey realized there was this real opportunity to use wearable data, the power of wearable data to measure and manage these conditions. And so once I was well enough, you know, about a year and a half into my journey, I started Visible and we've been going now for nearly nearly two years, two and a half years.

Zeest Khan (08:16)
So many of us share experiences of trying to

exercise our way out of it.

Before you started the wearable and tracking biometrics, what I was really drawn to with Visible was the way that you helped me track my symptoms. Can you tell us a little bit about that part of Visible?

Harry Leeming (08:39)
Yeah, so the wearable side of...

Visible has only existed for less than 12 months now. But before we launched the wearable, which is really where we've had the most conviction around, where we can have the biggest impact, we launched a free app that's still available that anyone can download. And what that free app does is it allows you to track your symptoms and we've kept it really simple. And we have this framework where you do a morning check-in and in the morning check-in, we can actually pull out some of the biometrics that you can pull out through

wearable simply by putting your finger on your smartphone camera. We have this amazing technology that can read the color of your fingertip using your camera sensor and it can interpret those small fluctuations in the color of your fingertip into heartbeats and it can actually do this to about 97 % accuracy versus sort of the gold standard consumer chest strap so a Polar H10 in this case and it allows us to get really incredible insights on your body and your baseline.

in just 60 seconds. So we had that in this morning, what we call a morning check-in. And then in the evening check-in, this is when we ask about how are your symptoms today at your worst? And it's just a very simple four point scale, mild, moderate, severe, very severe. And then we also ask about activity. So not just tracking physical, but also cognitive and emotional exertion as well, as well as the ability to track the menstrual cycle and any medication or lifestyle changes.

you've made. But I think one of really important things to us was that we didn't turn this into an Excel spreadsheet with a lot of admin. No one wants to have to think about their illness more than they have to. So how do we keep it really simple and only ask users for the information they need that will really be helpful for them in making decisions about how to manage their condition? And that's been really successful. We've had over 100,000 people use it.

Zeest Khan (10:16)
Mm-hmm.

Talk to me about pacing

What does pacing mean to you and what approach has Visible made towards pacing?

Harry Leeming (10:49)
Yeah, I mean, pacing is really tough because, you know, it can often easily be framed as a treatment and really it is very much management. mean, someone had a very good line that I saw the other day, which is that, you know, it's not a treatment, it's a sacrifice really, because you're doing less, but really ultimately, so you can do a bit more. And pacing is at the core of what we do at Visible with the wearable data. We have continuous heart rate data that we

Zeest Khan (11:03)
Mm.

Harry Leeming (11:18)
can then use to provide guidance because one of the tough things as you'll know is that as a patient you often feel like you're either doing too little or you're doing too much and you're just stuck in this boom and bust cycle of pushing yourself, ending up in bed for a couple of days and then going through these cycles again and again. And what we see our role at Visible is doing is helping avoid those boom and bust cycles. So letting you know when you're pushing yourself too much.

So take into account not just like how hard you're exerting, but also for how long are you exerting at that level as well. And then providing you notifications in real time to help you to slow down.

Zeest Khan (12:04)
when someone with long COVID has overdone it what's happening in the body that'll help us predict?

a crash

Harry Leeming (12:11)
So, I mean, I think the jury's still out exactly on how the physiology works around this. But what we do see happening in the nervous system, which is what we can pick up through your heart rate, because your heart rate is, and your heart rate variability are so intertwined with your autonomic nervous system, which is controlling that system on its own. And what we

in the data is that if your biometrics, if your heart rate variability or resting heart rate is starting to fluctuate, is starting to become unstable, that you are more susceptible to having a crash. And so that's a really good indication that you should slow down. So there are really like two things that you're looking for in the biometrics. You're looking for, in the case of your heart rate variability, for it to be a bit higher, but you're also looking for it to be stable.

and with your resting heart rate, again, you're looking for it to be stable, but you're looking for that to be a little bit lower. And those are real indications that your body is more resilient to crashes. And we've got some really exciting research that we're going to be publishing the next couple of months that's based on our considerable data set at this stage. have what we think is the largest data set in the world on intervention, symptoms, and biometrics, where we'll be able to back that up with the hard data.

What will follow that is an iteration of our algorithms using that.

that new understanding or that developed understanding that we've had over the last two years of running visible. And so that's slightly talking about the prediction or like the impending crash. What we see during a crash is classically your heart rate going much higher and classically your heart rate variability going much lower. But we also see these fluctuations in the biometrics. And actually this is where it can

to quite difficult to untangle the two because if your heart rate, for example, is fluctuating a lot, sometimes it can appear like it's much lower and therefore that's a good sign, but actually that's just a result of being in a crash. So it's trying to take both those.

aspects, and absolute value into account, which can be slightly difficult for people to get their heads around and that's why we have these scores that help to interpret that.

Zeest Khan (14:42)
we generally understand what baseline heart rate is. It is your heart rate at rest, oftentimes best measured when you're just waking up in the morning and you haven't had any stressors of the day yet. We know that lower resting heart rates are associated with better cardiovascular health.

Heart rate variability or HRV is really hot right now. It's used in a lot of wearables. Can you explain how you understand HRV and why should people with long COVID pay attention to

Harry Leeming (15:23)
Yeah, so I mentioned a few times, so heart rate variability, HRV, this is the measure of the fluctuation of your heartbeats. So one of the analogies I always like to use is for most people, a really nice, like low resting heart rate would be about 60 beats per minute. And what you would classically think is that if your heart rate was 60 beats per minute, that it would be, your heart rate would go one second beat, one second beat, one second beat.

In reality, if you really zoom in and measure accurately, it is more like 0.9 seconds beat, 1.1 seconds beat, 0.8 seconds beat. And it's these small variations in the time between successive heartbeats that give us a really clear indication or good indication of how your nervous system is adapting, how it's responding. so counter-intuitively, you having a metronomic heart rate, so a

every second that's not actually good that's the opposite that's bad what we're looking for is more adaptability you're looking for your heart rate to be flexible for it to be able to adapt and so you actually are looking for you know this 0.8 seconds beat 1.5 seconds beat these larger changes in successive beats and so that's a really nice additional metric to use alongside resting heart rate to understand your overall well-being and a really

good window into your autonomic nervous system.

Zeest Khan (16:56)
So in general, Lower resting heart rates correlate with better cardiovascular outcomes. We're starting to understand that higher heart rate variability, so a higher number of HRV, is also associated potentially with better cardiovascular health.

Harry Leeming (17:01)
Yep.

Zeest Khan (17:17)
I'm assuming is HRV measured differently by different devices.

Harry Leeming (17:23)
They are.

I think there are different ways that you can measure it and often it's easy to get caught up in the different ways to measure HRV but actually because your HRV is so individual to who you are it's not actually that helpful to compare it to other people and so even if all the devices available all measured it exactly the same way it still wouldn't be that helpful to be able to make those comparisons with other

people. And so the most important thing you're really looking forward is like, how are you doing relative to yourself, not relative to other people. And so looking at a one month baseline, a nine month baseline and comparing it against that is the best way to understand the direction that your health is going.

Zeest Khan (18:14)
So we're looking not just at the absolute numbers, but at the trends. And if our resting heart rate might be trending up, I can say, My body is really trying to work hard.

Harry Leeming (18:19)
Exactly.

Yep.

Zeest Khan (18:31)
I worry about using devices or depending on them too much because of this tendency to get obsessed with the number moment to moment. But it sounds like what you're saying, looking over a greater period of time.

what was our HRV at starting, what's our HRV at six months, nine months, 12 months. That's going to be more important and more helpful than a moment to moment reading. Is that right?

Harry Leeming (18:58)
Yeah, certainly for HRV because particularly HRV is extremely sensitive to stresses and that's why when we take the measurement we try and do it first thing in the morning when there is a little influence on your day as possible. You know, haven't got up, you haven't walked around the house, you haven't had too many thoughts that might shift it and trying to use that environment as like controlled environment as you can create first thing in the morning is what allows us to get a really nice baseline and to understand

your trends of your health over the long term. And I think it is good to talk about the different ways to manage these conditions because the HRV is really helpful in the long term and this long term management is what I'm doing. Are the lifestyle changes I'm making? Is the medication I'm taking? Is it having an effect? Is it having a good impact? Is it making me better? It's not making me worse. And so...

It's really helpful to do that. And that's why like the free app is still really powerful because it can still help you with this longer term management. And then with the shorter term, we've got the heart rate piece where we use the heart rate to help manage in that sort of hour to hour, even minute to minute. the, what we try and do is, and we think about this a lot of visible is how to balance showing too much information and creating more questions than answers. And so we,

we do think how we can make it as simple to use as possible so that you're not having to think about your illness more than you need to and you really can just get on with your day as much as possible and give you the freedom. And so, yeah, we work very hard on how to do that because I'm definitely with you. There's...

a lot of the apps and devices out there, you know, take a Garmin for example, there is a million metrics in there. You could get lost in all the things that are going on, but actually what's really relevant to you, what's actionable, what are you going to look at and actually be able to change about your behavior or about the way that you're managing your condition? Because if you're looking at a bit of data and it actually isn't going to inform anything that you're able to do, then we don't see that as helpful.

And so we really try and boil it down to only the things that really matter for these conditions and no more than that.

Zeest Khan (21:22)
I think that's helpful.

I am trying to integrate more physical movement because that's appropriate for me now, And I don't wanna overdo it. while I integrate an exercise routine, I don't wanna be paying attention to my HRV every single day.

This allowed me to say, okay, I'm gonna start this intervention I'm gonna note my HRV or my measures at this point, and then I'm gonna look at it again in a few months.

In developing this company, you have had to go through a lot of information of what measures should we actually pay attention to. In addition to HRV and heart rate, even if Visible doesn't track these, what are some biometrics that are of interest in this space?

Harry Leeming (22:17)
temperature, for example, is something that you can track and awareable and potentially could fit into this dysautonomia, this dysfunction of your autonomic nervous system of which like temperature regulation is also a part. That would also help us in being able to understand the health of your nervous system. But I think if you, if we were to sort of think a bit blue sky thinking other,

What other measures would be helpful? I think there are some interesting anecdotes around like lactate threshold and

the potential that that has. If you were to use that analogy of over trained athletes that sometimes is used for when you're in a crash. I think there are some potentially some science there that could pull over to these conditions. But as with a lot of areas, there is so much more research to be done.

Zeest Khan (23:12)
I didn't know much about the temperature alterations. it's reminding me of...

crashes around the menstrual cycle and you've paid attention to this that this is like a real thing that women are complaining of that we keep crashing around our cycle. When did it click for you that this was something that you needed to pay attention to?

Harry Leeming (23:34)
I mean, I think one of the interesting things about going through this condition is how much...

You listen to other people's health journeys and you take them seriously. and I was seeing all these anecdotes, online from friends and it was just hard not to be like, this is a really big issue that no one is researching or really talking about publicly.

one of the really cool things was that we were able to

and this has been really important for us, was being able to tie into research. we actually have the ability within the app, if you want to, to consent to share your data separately and anonymously with researchers in this space. So we have partnerships with Mount Sinai, with Imperial College London, we've got more coming, which we're really excited about, where patients can...

easily share their data. not only are they making their symptoms and what they're going through visible to themselves, they can better understand it and manage it, but also make it visible to researchers. So we can pull out some really important insights that in this very complicated group of conditions, like what patterns are we seeing and can we start to nudge research in certain directions where we see that more research could be done.

And so, it was one of the first studies that I was determined that we did.

visible. we have a really great set up to be able to track the menstrual cycle and symptoms. And so we partnered with Imperial College London to introduce an app, a study in our app, where anyone, if they're tracking their menstrual cycle, can opt in to consent to share their data, again, completely anonymized, completely optional. And they can share that data with researchers at Imperial.

really excited to say that we are very close to publishing a paper on this. And unfortunately, I can't share too much of the results. We have to sit on the results for a little bit longer, but as soon as we're able to, we'll be sharing that. We'll be sharing that within the app and with anyone that's...

signed up to provide their data for the study but I am excited with the findings and I hope that it will bring this aspect to the condition.

more into the public conversation. It will hopefully open up some treatments because I think there are some interesting things around hormones and our ability to use different treatments, different drugs to affect different parts of the menstrual cycle. So yeah, I'm excited to share more soon.

Zeest Khan (26:25)
I were excited to hear more because it is ridiculously debilitating. I imagine, that measurable biometrics change in the premenstrual, menstrual, and immediately after the menstrual cycle,

Harry Leeming (26:41)
we do. We definitely see changes and we definitely see, and we see changes in susceptibility to crash as well.

I think patients intuitively know this. Like they do, like there's a reason why their interest in their biometric data because they can deeply feel that something is broken and that can actually be shown in the biometric data.

I think diabetes is a really interesting analogy where you've got CGMs or continuous glucose monitors, which are able to track in real time your glucose levels. And I envision a world where we're able to do a similar level of management and measurement of these conditions using heart rate and heart rate variability. Because I think they are cool, so cool. Your nervous system, we know it is so intertwined with these conditions that having an action

Zeest Khan (27:06)
Mmm.

Harry Leeming (27:33)
way to measure them is only a good thing and particularly the conditions that just fluctuate as much as they do that actually even if we do find a test, a single time point diagnostic test for these conditions, we won't realistically be able to do that test every week, every day, every hour, but the beauty of the wearable data is that we're able to continuously track this aspect of the condition.

one of the tests available to us is this tilt table test.

And I think that is really interesting to think about how that translates to wearable technology because essentially what you're doing on a tilt table test for those that aren't familiar is you lie down on sort of looks like a torture table. You lie down and your heart rate is taken, your blood pressure is taken and you're shifted into an upright posture and your biometrics are recorded all the way through that and you're able to see your body, your nervous system's response to this change in

posture. What's fantastic about wearables is that we know what

body position you're in. have a rough understanding of whether you're lying down, whether you're sitting up, whether you're standing. And of course we're tracking your heart rate the whole time. And so to be able to combine your posture and your response to changes in posture, I think is there's an opportunity here to replace that kind of test with something much more accessible and that is continuously measuring you.

when I look at

wearable technology and the application of heart rate sensors, it's hard to not see these conditions as one of the best use cases out there for this type of technology.

Zeest Khan (29:22)
What's in the future for Visible? What's your ultimate dream?

Harry Leeming (29:28)
I think a lot of this is tied into our name. is around making these invisible illnesses, these conditions that we currently can't measure, at least not very well, or as accessible to many of us.

these conditions visible to patients themselves so that they can better understand and manage their own illness, making it visible to their caregivers, their friends and family so they can better support them. But then it's also about making them visible to the healthcare system. making these conditions visible to clinicians, to physiotherapists so that they can better treat you. And really the thing that motivates the team at Visible

all half of us have these conditions is increasing our understanding. This is what really motivates us, like finding more answers to what is going on. And so making these conditions visible to researchers. So these research partnerships are what is, I think, one of the most exciting parts of Visible because a lot of the research that we do with our partners, we're pouring back into the app. And I'm really excited about the next six months.

with these new studies that we have with Imperial College London, Mount Sinai, with the patient-led research collaborative to be iterating and continuing to improve visible and improve our understanding of these conditions. And I remain very optimistic and hopeful that we will get more answers over time. And I hope that visible plays a part in that and shifts our understanding forwards, even if it's by a couple of days in the grand scheme of things, given how many people are affected.

by these conditions I think we will have had an important impact.

Zeest Khan (31:21)
Is there anything that we didn't cover that you would like people to know?

Harry Leeming (31:27)
I think I've managed to shoehorn in there that the T half the team have got lived experience. Cause I do think that's all was a really important point to make, which is the, you know, we, we do deeply understand these conditions and what people are going through. and it's like, we're on, we're on that team. think a lot of people feel quite rightly alienated from the healthcare system that no one understands them. No one's listening. I think it's important that people know that there is a.

growing group of us that are working on this full time who do deeply understand these conditions and are very motivated to find answers and solutions.

And we've tried to be as transparent as possible. Like in our website, we write a blog where we keep people updated on the decisions we're making, why we're making them, who we're partnering with, why we're partnering with them. Because I do think it's really important.

especially in this world where it feels like a lot of the information and the latest information is gate-kept behind journals or waiting for publications to come out. That was really frustrating having to say that I could share with you our latest findings because we have to wait for academia. But I hope we can do our bit to give a bit more transparency, a bit more hope because there is progress happening.

Zeest Khan (32:49)
Do you wanna plug the podcast?

Harry Leeming (32:52)
Yes, so one other thing that I forgot is that we, last week, just launched a podcast and our podcast is called Make Visible. It is hosted by incredible Emily Kate Stevens, who also has long COVID and is an ex-journalist, ex-TV producer, who previously ran the Long COVID Sessions podcast and has now joined Visible, not just to help shine a light on

long COVID, but all of the other chronic conditions that overlap so significantly with this condition.

looking at how we can tie these conditions and what the similarities and what the differences are between them all because our belief on the team is that any breakthrough in one area will have huge ramifications for these other conditions and so trying to look more broadly at these chronic conditions outside of long COVID.

Zeest Khan (33:48)
Absolutely, I've said here on the podcast multiple times that we didn't land in this situation where we have a complex illness that doesn't have answers. Alone, we jumped into an existing community and a structure of medicine that's prevented us from getting answers. I commend you for trying to link.

those communities even more.

tell listeners how they can learn more about Visible and what options Visible provides.

Harry Leeming (34:21)
So you can find out more about us on our website at makevisible.com. You can also follow us on Instagram at visible.health.

And if you are interested in using visible to manage your condition, we have the free app which is available to download on both the Apple and Android app stores. And if you'd like the wearable access to real time continuous passive measurements of your heart rate and heart rate variability, then you can become a member of visible and you can do that through our website.

We have a small, what's the word?

We have a short quiz that you can take that will let you know if Visible is suitable for you and makes sense for your condition.

Zeest Khan (35:10)
Harry Leeming, thank you so much for dedicating your energy to this cause. I know it's helping you and a lot of the people on your staff who are actually affected with these conditions, but it's also helped me and it helps a lot of other people. So thank you for your efforts and thank you for joining me today.

Harry Leeming (35:31)
Thank you, Zeest

Zeest Khan (35:38)
I loved that conversation with Harry and I'm excited to see how Visible evolves over the next few months and few years. As I reflect on our conversation, I see two big takeaways on using wearables, whether that's Visibles or another.

One is that there is such a thing as too much information. It might feel good to have tons of biometric data or otherwise, but the data is not helpful until it's organized and patterns are detected. I'm thinking about the spreadsheet analogy Harry made. I might have a ton of information, but what I really want is

pertinent information that's easy to understand. By pertinent, I mean I want information that will help me make decisions. In medical training, we learn to, before we order any tests, we ask this question, how will the result change my decisions?

And that's how I approach biometric data. I wanna measure what's gonna help me make decisions. It is of course harder in our situation to tease out what those measurements are because there are so many unknowns. We might not know what is relevant or what is not in the long run, but I...

But in the short run, I can tell you there are some esoteric measurements on some of these biometrics that's not gonna impact any treatment that you have access to or that even exists. So even though there are big question marks, I invite you to review what you're tracking.

and to see if you can simplify it. What here that I'm paying attention to is helping me make decisions.

My second takeaway is to focus on trends, not absolutes. Now, there are dozens of articles and videos on heart rate variability specifically, and they'll tell you what your HRV should be. But I guarantee that those numbers have loads of caveats, and those numbers are likely nowhere close to where you are.

comparing your numbers with someone else's numbers or comparing your numbers to what someone else says your number should be can make you feel pretty bad. It can make you feel stressed. It can make you feel like you're failing. It can make you feel like you're in danger.

A better use of your time is to compare yourself to yourself. Has an intervention made you feel better? Has an intervention affected a number that you're tracking? Those could be the same question. They could be two different questions. So compare yourself to yourself. And related to this, in order to really see a trend, we have to remember that we need sufficient time.

So let me use the example of food. I have seen people talk about how their heart rate variability or another biometric changes immediately after a certain meal. Now here's the thing, a lot of things happen when you eat and many factors impact HRV and all these other biometrics that you're measuring. So comparing your...

is comparing a number before and after a meal is not necessarily reliable. And it's certainly not as helpful as tracking HRV over a period of months, let's say after you implement a specific diet. So there's a difference between comparing your HRV before and after a meal and comparing it before and after

a diet lasting six months. So I encourage you to zoom out when it comes to biometrics and look at these numbers over time as a trend and not so much as absolutes at any given time.

What are your takeaways? How do you use wearables and how do you track symptoms? I'd love to hear from you. Email me at longcovidmd at gmail.com. And if you haven't yet, subscribe to my Substack, longcovidmd.substack.com. It is growing rapidly and you can send me a message there. I'm really excited to see the community grow there and to meet you all over there.

That's it for this episode of Long COVID MD. I'm Dr. Zeest Khan. I hope you're feeling well in this moment and if not, I hope you feel better in the next. Take good care and bye for now.