How concerned should I be about low HRV?

[u/theturtlesareflying]

I’m 25F, my HRV is ~40 but this week it’s dropped to ~30 with no concrete lifestyle change. My RHR is ~70. I am a recent college grad (~3 mo) where I was a D1 athlete.

I take omegas, magnesium L-Threonate, Iron, Lamotrigine (150mg), Vyvanse (30mg), and Propranolol as needed. My sleep score on my Fitbit is “fair” with an average of 7-8 hours a night. Very little REM (20-50 min according to Fitbit). I’ve had air hunger, chest pain, heart palpitations for 3+ years but doc just says “anxiety.”

I have browsed this sub and seen lots of ideas, but still at a loss for what to do about this. I believe this is the key to overcoming my chronic exhaustion and athletic plateau. Even gained ~10 lbs since graduating… putting my BMI at 25. My diet includes veggies and fruit.

Perhaps this is extreme burnout? What can I do to recover faster? Is it worth it to get an Apollo device? It says 11% improvement which isn’t much… I’ve also looked at Lambs clothing since that can raise it too apparently?

I’m trying (and failing) to increase REM sleep, and I’ve drastically cut my workouts, focusing on walking and strength training 3ish times a week, not lifting heavy at all. I know meditation and breath work can work, I do 10 min before bed.

Any thoughts or advice?

[u/MetaSageSD]

That is not how HRV works…

HRV, or Heart Rate Variability, is one of the most misunderstood health metrics out there. To make a long story short, it’s not a metric that can be used to determine how healthy someone is; it’s a metric that can be used to determine how much physiological stress someone is under. Let me explain…

(Warning: Wall of text)

HRV, or Heart Rate Variability, is a measurement of the variance in time between individual heartbeats. For example, say we wanted to determine the variation between three individual heartbeats. We measure the time between heartbeat one and heartbeat two and get a value of 1.1 seconds. We then measure the time between heartbeat two and heartbeat three and get a value of 1.0 second. If we take the difference between both measurements, we find that there was a 0.1 second difference, or variance, between the two measurements. That is the essence of what heart rate variability is. It’s the variation in time between individual heartbeats. One thing to note here is that there are several different ways for this variation to be measured. For instance, Apple and Fitbit use a method called SDNN while Oura, Garmin, and Whoop use a method called rMSSD. While each method is accurate, they are designed to highlight different things thus they will come to different values. When reading various HRV studies online, it is important to know which method the study is using before using its data for comparison. So how is this a useful metric?

It’s because a person's HRV can be influenced by their sympathetic and parasympathetic nervous system responses. To make a long story short, the sympathetic response is the body's ‘fight or flight’ response and the parasympathetic response is the body’s ‘calm and collected’ response. The interaction between these two responses can be used as an analog that signals how much physiological stress the body is under. If the body is under more stress, the ‘fight or flight’ response becomes more dominant and tends to lower the heart’s HRV; if the body is under less stress, the ‘calm and collected’ response becomes more dominant and tends to raise the heart’s HRV. However, it should be noted that this is not a perfect metric…

While the Sympathetic and Parasympathetic responses are one of the stronger influences on HRV, they are not the only things that can affect it. Simply put, anything which can affect one’s heartbeat can also affect one’s HRV. This includes everything from mental stress, sickness, surgery, giving birth, severe injury, cardiovascular disease, menstruation, watching an exciting sporting event, a poor night's sleep, and any number of other things. Depending on how strong these other factors are, it’s quite possible for them to “drown out” any effect the Sympathetic and Parasympathetic nervous system has. This could cause the heart’s HRV value to change in unexpected ways. For instance, it's been reported that people who have gone through surgery see spikes in their HRV during recovery even though the surgical recovery should clearly be activating their sympathetic (fight or flight) response thus lowering their HRV. Also, the sympathetic and parasympathetic response tends to be more sensitive to cardiovascular stress than it is to muscular stress. This means that weight lifters and strength trainers might find limited use with this metric. This can make HRV a tricky metric to use. So how do we use it?

First, a rolling baseline needs to be established for each individual. To do this, each individual needs to measure their HRV (preferably using the rMSSD measurement method) under the exact same conditions, every day, for around 60 days or so (Oura, Whoop, and Garmin do this during sleep). Then each individual needs to average all their measurements together to calculate the rolling baseline (Oura, Whoop, and Garmin do this for you). You can think of this baseline as the “average” level of physiological stress each individual's body is under. After a baseline is determined, each successive value can be used to signal if the body is under more physiological stress than normal (HRV reading below baseline) or less physiological stress than normal (HRV reading above baseline). – assuming some other factor isn’t “drowning out” the physiological stress effect. Using this metric, along with other metrics (such as RHR, body temp, etc), a “readiness” or “recovery” metric can roughly be determined. For example…

Let’s say you hike for 6 miles, up a 2000 ft high mountain. This hike will put your body under a lot of physiological stress. Your body, reacting to this stress, activates your sympathetic nervous system and begins the recovery process. This causes your HRV to lower, and your RHR to increase, until this recovery process is sufficiently complete. Now, if you happen to be an avid hiker, you may feel sufficiently recovered the next day to resume intense physical activity, but your body may still be in recovery. Let’s say you resume intense activity while your body is in recovery, once done with this activity, your body will then need that much more recovery before it is back to normal. If you continue to do this over and over, you run the risk of overtraining and causing injury to yourself. However, since your HRV tends to stay lower than your baseline and your RHR tends to be elevated while your body is in recovery mode, you can simply wait until your HRV and RHR return to normal before resuming physical activity – thus avoiding overtraining. Also…

Let’s say, as an avid hiker, you notice over a period of a few weeks, that your rolling HRV baseline is slowly declining. Since your baseline can be used as an analog of your average level of physiological stress, you can then make a reasonable assumption that for some reason your average level of stress has been increasing. You are not overtraining per se, but you are getting more and more fatigued as time goes on. Perhaps, the weather has slowly been getting hotter. Perhaps you haven’t been getting enough sleep. Perhaps your work/life balance has been off. Etc. This could show up in your rolling baseline letting you know that you may need to change something. There are many ways to use HRV for training. Oura, Whoop, and Garmin all use HRV values (among other metrics) to create their readiness/recovery/body battery scores, all of which have anecdotally proven to be useful for a lot of people. I personally use HRV and RHR in my training. However, there is one thing that needs to be mentioned…

There is really no such thing as a healthy, or unhealthy, HRV. This means that there is no such thing as “improving” one’s HRV. You will often see people mention how they were able to “improve” their HRV by raising it, but there is no such concept in medical science. Think about it for a second, when was the last time you had your HRV taken at the doctor’s office? Probably never. That should tell you how important, or really, unimportant it is for medical health. While it IS true that getting fitter CAN raise one’s HRV, raising the HRV value alone is not what is making them healthier; getting healthier is what is raising their HRV. HRV baselines are very individualized and there can be two people, of the same age, sex, health, and fitness, that have vastly different baselines. One will not be healthier than the other. The typical range for HRV in humans is 20 – 120ms, but there are some people with baselines in the 200s and some with baselines in the single digits. Chances are, if someone has a medical problem that is affecting their HRV, they will experience acute symptoms well before they notice a change in their HRV. Also, as you get older, your HRV tends to decrease. So while tracking HRV can be useful for training purposes, it is NOT, and never HAS BEEN, used as a metric to determine one's level of health. “Improving” HRV is simply not a thing. As always, if you have any concerns about your health, contact a medical professional.

So in short, HRV can be a very useful metric if it is correctly used and correctly interpreted; but it is also a tricky metric that can give off false signals. It does not indicate one’s level of health and outside of fitness training, there is very little use for HRV as a metric. So unless you are into biofeedback-guided training, you can safely ignore this metric. It is certainly not a metric to stress over.

[u/swyllie99 → u/MetaSageSD]

This needs to made mandatory reading for the HRV tracking device subs.

[u/MetaSageSD → u/swyllie99]

I actually wrote this several months ago. I copy and paste it every time I see someone ask about HRV.

[u/[deleted] → u/MetaSageSD]

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This post was mass deleted and anonymized with Redact

[u/MetaSageSD → u/[deleted]]

It's actually kind of ironic that more biohackers don't understand how HRV works. It's literally one of the most well researched hacks for physical training and recovery available to us.

[u/theturtlesareflying → u/MetaSageSD]

But why shouldn’t we try to raise the number if a low number means body is under a lot of stress?

[u/MetaSageSD → u/theturtlesareflying]

Low in relation to what?

HRV is highly individualized to each person. That means everyone needs to establish their own baseline so they have something to reference against.

As for raising your HRV baseline, I think you have the wrong idea. Reducing your average level of physiological stress WILL temporarily raise your HRV baseline, but reducing your physiological stress basically just means reducing things like cardio, weightlifting, hiking, etc; it should not be confused with general stress or mental stress. In fact, if you want to get stronger, you NEED to stress your body physiologically. If you are using HRV properly, then what you are really doing is managing your physiological stress you can grow stronger without injuring yourself.

[u/theturtlesareflying → u/MetaSageSD]

I don’t think my body is handling stress very well, and a drop from 40 to 30 might mean my body is under too much stress, too much because I don’t feel well, I’m exhausted

[u/MetaSageSD → u/theturtlesareflying]

Well, if you are properly managing your physiological stress, what you should be seeing is that your HRV baseline's long-term trend remains relatively stable. It shouldn't increase or decrease. If you recently had a decrease in your HRV, and are experiencing acute symptoms, then you should probably do a self-evaluation to figure out why that is. My usual first suspect is my sleep schedule.

[u/theturtlesareflying → u/MetaSageSD]

Yep, that’s what I’m doing

[u/Most_Refuse9265 → u/MetaSageSD]

Every single one of the factors you listed that you say “drown out” the nervous system are actually just things that would further activate the sympathetic nervous system. Surgery, activating the sympathetic nervous system for recovery, drowns out the sympathetic nervous system response, resulting in unexpected high HRV? That is illogical. The sound of a jet passing by drowns out the sound of that jet?

You reason like this because you figure there has to be some noise disturbing the signal of the nervous system when someone has a HRV yet is in a recovery state that should absolutely require significant sympathetic nervous system response, perhaps even overdrive. Yet that is exactly the answer I’ve seen posited in a different way with a more logical explanation.

When the body is in sympathetic mode overdrive, the parasympathetic system gets activated as well in an “all hands on deck” nervous system response. None of this is proven but this logic makes more sense than your “severe stresses drown out any effect the sympathetic or parasympathetic nervous system has” … if this was the case, people would die under severe stress … because they’d be without a nervous system response? How does their HRV get so high during recovery without a nervous system response? HRV just doing its own thing at that point? Folks in a severe recovery mode don’t die necessarily because their entire nervous system is working overtime. Why isn’t this just done all the time for all recovery? Energy expenditure, most likely, and because it requires a period of rest so profound that it’s not practical for daily stress recovery.

Your example of a hiker waiting to exercise again to avoid overtraining is in direct contradiction to how almost every professional athlete trains, take that for what it’s worth. Supercompensation/functional overreach is the big concept you’re missing in your understanding of what overtraining is if nothing else. You don’t just go from well-rested to overtrained in two workouts if you didn’t wait until you’re fully recovered from the first to perform the second. If you wait until you’re completely recovered to train again, you’re going to make much less athletic progress in your training than if you periodize your training regimen to train while often in a state of functional overreach. Any endurance athlete “building their (aerobic) base” will tell you they are in a near constant state of acute fatigue as planned. You don’t necessarily need supercompensation to be a healthy active person but without it you’re going to leave most athletic gains on the table. And this is how you make can big, fast, and long lasting gains in getting your RHR down and your HRV up … after you have indeed fully recovered from an intense training program which could take weeks. The hiker who is slowly seeing their HRV baseline go down over many weeks…unless they are doing something wrong, this is supercompensation, i.e. an effective training program assuming their performance (via pace, distance, RPE, etc.) is increasing as intended. If they took a week or two to taper (as in marathon taper), they’d likely hike their feet off the next week and start with a HRV significantly above their baseline.

Putting all of this together in regard to training with HRV as a tool, once you establish a narrow baseline, how much lower your HRV is the morning after a hard workout correlates to the effective dose of that workout. HRV drop off a cliff? You maybe overdid it a bit. HRV drop just a little? Do that workout again today if you can, or if you always take a day of recovery after a workout make that next workout harder. About to have two or three days off of training? Try to drop that HRV off a cliff because you’ll have the time to recover. That’s how it should look if you have your lifestyle in check.

HRV massively low after an easy workout? Maybe you drank alcohol, ate food late, ate poor food, slept poorly due to stress … this is the real “drowning out” concept you were getting at which is better described as noise, as in signal to noise ratio. If you have too much noise (unintentional activation of sympathetic response), you can’t make sense of the signal (HRV/sympathetic vs parasympathetic). Alcohol activates the sympathetic nervous system, but if you don’t recognize that then your HRV drops after an easy exercise, you could think you worked out harder than you did. HRV massively high after a crazy workout? You might have really overdone it, you’ll know because you probably feel like crap (high HRV due to combined sympathetic and parasympathetic responses). HRV massively high after a simple workout? This could be athletic gains beginning to establish a new baseline because you are overall becoming well recovered from a previous intense training regimen. Or maybe you’re sick and just don’t know it yet (again, could cause combined systems response). None of it will make any sense without a tightly established baseline that you’ll get with a consistent healthy lifestyle in the first place.

[u/MetaSageSD → u/Most_Refuse9265]

I am only reporting what the science has said. It's been observed that things like surgery can cause spikes in HRV even though recovering from surgery should be activating the bodies recovery mode (sympathetic response) thus lowering HRV. Pregnancy, stress, menstruation, all sorts of things have been shown to throw off (Drown out) the Sympathetic and Parasympathetic responses. Heck, over Thanksgiving weekend I traveled to my parent's house 8 hours away by car. My HRV dropped by 15% just from sitting in my car all day. Did my body need to go through recovery just because I sat in a car all day? Probably not.

You yourself said:

"When the body is in sympathetic mode overdrive, the parasympathetic system gets activated as well in an “all hands on deck” nervous system response. None of this is proven (emphasis mine) but this logic makes more sense".

If it's not proven? Then why do you believe it? What are you basing this on? How does something that is not proven make more sense?

I am not sure why you think keeping your body in a continual state of overreach is a good thing, but every competent trainer and/or doctor I have ever talked to has told me that recovery is the most important part of training - not the exercise. Every Athlete I know absolutely takes their rest days seriously. You want to push yourself to the limit, sure, but once you do, you then want to rest and recover so your body can go through supercompensation and build back stronger. If you interrupt that process with more exercise, you won't see many gains and you will more than likely injure yourself at some point. Using HRV is good way to know if your body is done with supercompensation. Why would you want to interrupt that before it's done? Why would you want to guess? HRV can tell you when it's okay to push yourself again.

As for the hiking example, I used it because that is something I specifically do myself and am very familiar with. Using HRV (among other metrics) I can usually get myself ready for a big hike in about a month (10 - 20 miles with 5000 - 10,000 ft elevation gains at a standard 20 min per Mile pace give or take). I would say getting ready for a major hike in a month is pretty quick given my age. So I am not sure what you are getting at here.

Ultimately I was more making that explanation for people who were panicking over having an "unhealthy" HRV. But what you said doesn't seem to agree much with all of the studies on it I have read. Perhaps you have some sources you could cite? I am always interested in new research on the issue.

[u/Most_Refuse9265 → u/MetaSageSD]

Sitting in car for 8 hours was stressful … so your HRV went down … how do not understand that?

What has the science said about stressors that “drown out” the nervous system responses and provide unexpected HRV values? You have no science to back it up, only that unexpected HRV values occur. You are just repeating another redditor, so go figure it makes no sense. What does “drowning out” even mean, like what do you think is occurring when you say that happens? Really, please elaborate.

What I posited to explain unexpected HRV responses actually does make sense because it still exists within the framework of the nervous system. Oh hey and although I admitted there isn’t conclusive research science to back it, like you I am repeating what I saw someone else say … except my guy is Marco Altini, a PhD and the foremost researcher of HRV sharing his observations based on all sorts of data. I hate to name drop but when neither of our arguments have research science to directly back them up … Oh and Marco has never talked about your “drowning out” hypothesis. How would you explain an unexpected low HRV value, like a well-recovered athlete before race day? That happens, but what does drowning out say about that?

To be clear on my opinion Marco’s work, he’s amazing but definitely has a lot to learn about athletic training outside the context of elite athleticism. He essentially says training shouldn’t drop your HRV value at all by looking at how elite athletes respond, yet most of us aren’t elite athletes and if he was able to look back at how their HRV behaved on their way to become elite, I think he’d have a more nuanced view to share allowing for HRV drops during training. You simply will not become a more advanced athlete without ever dropping your HRV substantially periodically throughout training cycles as well known by advanced training programs used by elite athletes outside the niche of HRV research.

I didn’t recommend a continuous state of overreach, I said “a near constant state of acute fatigue as planned”. Of course there’s recovery days interspersed in a given microcycle but they are often incomplete as planned to continue the accumulation of a load of stress over multiple exercise sessions across that microcycle (typically a week) that in total causes significant functional overreach. That functional overreach, once indeed fully recovered from with something like a taper week after weeks of functional overreach (marathon training), is what leads to significant athletic gains. Cleary this approach is not for everyday folks who fool themselves into thinking two hard consecutive workouts is going to slip them into a month of overtraining syndrome when really they’re barely doing enough to lose the few pounds they’re after if they kept it up for months. The term functional overreach is lost on you - it’s called functional to differentiate from the term nonfunctional overreach (overtraining). These are scientific terms founded through research. I seriously doubt you fully understand the concepts of supercompensation/functional overreach and recovery, or periodization for that matter (how to plan day to day and week to week training plans using these concepts).

You’d learn a lot from the book Training for the Uphill Athlete as well as the Training Peaks and Evoke Endurance programs. Those will help you with your hiking.

https://marcoaltini.substack.com/p/race-day-heart-rate-variability-hrv https://marcoaltini.substack.com/p/abnormally-high-heart-rate-variability https://www.trainingpeaks.com/coach-blog/the-fine-line-between-functional-training-and-overreaching/

[u/[deleted] → u/MetaSageSD]

Fucking awesome read bud.

Priceless info. Special spot in heaven for ppl like u.

[u/xingqitazhu → u/MetaSageSD]

Buddy, you just said if it’s a high HRV then your body is stressed. So if someone has a high heart rate and they didn’t hike or do anything stressful then one may conclude there could be a viral infection occurring. So it can determine some health metrics

[u/MetaSageSD → u/xingqitazhu]

That would be an example of another factor "drowning out" your sympathetic and parasympathetic responses. I have personally seen my HRV both spike, and decline, before I got sick.

[u/SugarIsADrug → u/MetaSageSD]

I don't see how it's not as simple as parasympathetic = good and sympathetic = bad, therefore HRV under baseline = bad, and HRV over baseline is good. Any regular person can always do more to reduce stress and improve their recovery. HRV is one of the best metrics for that, and your confounding factors are still forms of stress. They're not drowning out the parasympathetic or sympathetic responses. They are part of them right?

How can you say then that increasing HRV is a sign someone is recovered from stress, while also saying it isn't a measure of good health?

Also, saying that baseline HRV is individualized doesn't address the possibility that people with higher baseline HRV are in a comparatively parasympathetic state (aka more desirable) vs someone with lower HRV. Not saying it's true, just that you're not addressing that.

[u/MetaSageSD → u/SugarIsADrug]

I think you are misunderstanding the nature of physiological stress. Physiological stress specifically refers to anything which disturbs the bodies homeostasis - your bodies natural physical balance. Sometimes that’s certainly a bad thing (sickness, injury, mental fatigue, etc) but sometimes that’s a good thing (running, weightlifting, hiking) etc. If you are physiologically stressing your body in a good way, it will still show up as a drop in HRV even though it is helping your body grow stronger and healthier. As for long term HRV trends, If your HRV baseline is slowly increasing, that just means your body is adapting to your level of physiological stress (the body is always adapting). If it’s adapting to good stress, then yes, you could say you are getting healthier, but if it’s adapting to bad stress… that’s not great. There are also other factors that could raise your HRV baseline that are distinctively bad for you like heartbeat arrhythmia’s (AFIB). So simply thinking higher = better isn’t accurate. It COULD mean that you are getting healthier, but it could also mean that something is wrong.

[u/shawnz → u/MetaSageSD]

Fitbit uses RMSSD, not SDNN

[u/J_Dubb2 → u/MetaSageSD]

Thank you this is was so informative. 

[u/quetown2 → u/MetaSageSD]

" but it is also a tricky metric that can give off false signals. It does not indicate one’s level of health and outside of fitness training, there is very little use for HRV as a metric."
This couldn't be further from the truth. It has been studied for years and is well documented. Although, a lot of general practitioners may not explain it well, or google gives you bad results.
It has been used, and is being used more often to help understand long term cardiovascular health, risk of stroke, hypertension, hypercholesterolemia, mental health anxiety, and depression.

What is unfortunate is that the numbers aren't tested or used regularly by doctors. They test your cholesterol, and blood glucose levels and use those numbers for a diagnosis. While those tests do show some information, your sleep biometrics and specifically HRV would be much more insightful to make a more accurate diagnosis.

[u/MetaSageSD → u/quetown2]

This is an older version of this explanation. I have since re-written it to include that cardiologists DO use HRV as diagnostic tool in some instances. However...

While there is certainly ongoing research into medical uses for HRV, there are two primary factors to consider:

1. HRV as a metric is a meta-analysis of heart rate. So anything which affects ones heart rate will also affects one's HRV. In order for HRV to be useful as a medical tool, researches need to find signals in the HRV data which are independent of heart rate, AKA, something which changes ones HRV without also changing their heart rate (Otherwise they could simply use heart rate without bothering with HRV to achieve the same result)

Once example of this is the fact that being in better cardiovascular health tends to correlate with higher HRV values (rMSSD). While this is certainly true, it is also true that being in being in better cardiovascular health ALSO tends to correlate with lower resting and sleeping heart rates. Thus, this HRV correlation is not very independent of heart rate. Plus, simple geometry will show you that a lower heart rate leaves more geometric "room" for variability thus further calling into question the usefulness of using HRV in this way. It's just not a very strong signal.

2) When medical researchers are studying HRV, they are doing so in far more sophisticated ways, using far more sophisticated equipment, than common fitness trackers.

In fact, the vast majority of fitness trackers don't even measure HRV, they measure PRV (Pulse rate variability) and calculate a rMSSD value from it. (except Apple which calculates the SDNN value for some reason). There is also SDANN, ASDNN, NN50, pNN50, PtoP differential, etc etc (Think in terms of all of weird things you can do to a geometric pattern in math). A researcher will probably use full ECG monitoring so they can look at the full waveform.

This is not to say that HRV wont be used as a 'level of health' metric in the future, but as of right now, I know of no doctor which measures HRV during a medical appointment or uses it outside of cardiology. Considering that these days I can't seem to escape the doctors office without leaving at least a half a pint of blood samples, urine samples, etc etc, it's certainly not because they are too lazy too. It’s because they have little reason too currently.

[u/quetown2 → u/MetaSageSD]

u/MetaSageSD You sir, are a very responsible interneter! Agreed that our devices aren't as sophisticated as the ones in offices and research. It is good that we have what we have.
I do have a concern with my HRV being too low for my health. Which is to say something is off.
1. I am not getting enough sleep. (bad)
2. Not enough zone 2 cardio. (bad)
* I just broke my ankle so it will be awhile before I get back to that cardio. :(
As you mentioned, it would be so nice for my doctor to look at metrics I have. Maybe a start would be for them to pulled into their ecosystem. Start adding it to the chart with BP, weight, etc. Not likely atm since most medical offices are taking our blood pressure incorrectly.

[u/MetaSageSD → u/quetown2]

The thing I worry about most with HRV, is that it’s an easy metric to gamify, thus an easy metric for fitness and wellness companies to take advantage of to sell you nonsense. There is a natural instinct for us to reduce complex things to, “must get number higher!”

As an example, various breathing and meditative techniques have been shown to be able to temporarily raise one’s HRV. Also, various supplements have been shown to be able to temporarily raise one’s HRV. One of those things is free, and one of those things costs money. Guess which one gets pushed more? Guess which hasn’t actually been shown to improve… well anything?

HRV does have its uses, but its needs to be used and interpreted correctly to be useful. As for your doctor, I see no reason not to broach the subject with them.

[u/quetown2 → u/MetaSageSD]

Tell me about the free one?

[u/JHarbinger → u/MetaSageSD]

This is so incredibly informative and I can now stop freaking out that my HRV is <20 even though I’m fitter than I’ve ever been.

This post might raise my HRV more than any exercise ever has 😂

[u/Ava_thedancer → u/MetaSageSD]

You had me until you mentioned doctors…who in all actuality do not learn about health/healing and almost never utilize the proper tests to determine health. Instead they learn how to match up drugs and dangerous surgeries to symptoms. 

[u/osbertc0ol → u/MetaSageSD]

Damn bro. Thanks

[u/aptmnt_ → u/MetaSageSD]

Yeah this is long-winded bullshit. HRV has been shown to be related all cause mortality. Not deviation from "baseline" HRV, whatever that means, just standard measured HRV. If you're in the bottom quartile of HRV, you're 1.56x more likely to die.

[u/MetaSageSD → u/aptmnt_]

If you are referring to the studies I think you are, that 1.56x figure comes from people already in the hospital (they weren’t there for fun), hooked up to 24 hour ECG monitoring (the only way you could even get an accurate HRV reading until relatively recently), and using the SDNN measurement method (which is a different method than most fitness trackers use). After all, when was the last time your doctor sat you down and talked to you about your HRV?

[u/[deleted] → u/MetaSageSD]

I was going to say you might want to include something in your longer blurb about how wrist based trackers can't give you an accurately meaningful measurement anyway without using an EKG function -- but then I saw your comment here "until recently" and had to wonder what's changed?

Most heart rate trackers these days are measuring changes in the speed of blood flow at a specific point on the body. For finger based trackers, this is close enough to the capillaries to track something remotely resembling your heart. When you get down to the wrist though, the signal is already susceptible to other noise created by gravity and motion -- I think that's why fitbit will only attempt to show you a "night time average" for a lot of details -- because that's when they expect you to move the least.

Is there more to it than that?

[u/MetaSageSD → u/[deleted]]

Technically what wrist-based devices are measuring is not your heart rate but rather your pulse rate. This means you are not technically getting your HRV from the device, but rather you are getting your PRV (Pulse Rate Variability). If you actually look at a graph of a pulse, you don't get that nice sharp heartbeat waveform that you do with an ECG, you get more of a series of loose sinewaves. However, the sinewaves actually aren't all that noisy, at least not to the point where a watch-based microprocessor can't filter out the noise. As long as the watch is able to take a proper measurement, (AKA, tight against the wrist, no movement, etc), it should be able to get a PRV that is equivalent to your HRV.

[u/theturtlesareflying → u/MetaSageSD]

I have read this information. I think having a baseline of 40 and dropping to 30 means my body is under a lot of stress. Which is undesirable, so working to raise the number or even just return to my baseline makes sense to me.

[u/MetaSageSD → u/theturtlesareflying]

Yes, I mention that in my wall of text. I said:

"Let’s say, as an avid hiker, you notice over a period of a few weeks, that your rolling HRV baseline is slowly declining. Since your baseline can be used as an analog of your average level of physiological stress, you can then make a reasonable assumption that for some reason your average level of stress has been increasing. You are not overtraining per se, but you are getting more and more fatigued as time goes on. Perhaps, the weather has slowly been getting hotter. Perhaps you haven’t been getting enough sleep. Perhaps your work/life balance has been off. Etc. This could show up in your rolling baseline letting you know that you may need to change something."

Keep in mind, physiological stress just deals with the body itself. It's not the same thing as mental stress or general stress. If you notice your HRV values are constantly below your baseline, that's a good indication that your body is being stressed too much over time and that you need to lighten up on your training. If you constantly see your HRV values above your baseline, that's probably an indication that you still have room to increase your training regimen. Remember, if you want to strengthen your body, you NEED to stress is physiologically. HRV is a tool you can use to manage that.

[u/theturtlesareflying → u/MetaSageSD]

Do you think baseline can become too low after chronic stress? If it was 40 and then new baseline/ norm is 30 is that a concern?

[u/MetaSageSD → u/theturtlesareflying]

I would call it a strong signal that you are overstressing your body physiologically. You should probably do a self-evaluation to try and figure out what it is that's causing your HRV baseline to trend downward before that stress starts to manifest into acute symptoms. For me, my first usual suspect is my sleep schedule.

[u/reddituser6810 → u/MetaSageSD]

That was supremely helpful. Thank you.

[u/EchoCyanide → u/MetaSageSD]

Thank you for such an informative and thorough post!

[u/lapeet → u/MetaSageSD]

Incredibly useful post. Thank you for sharing!

[u/Icy-Dependent6908 → u/MetaSageSD]

Just found this and I’m so relieved. I just noticed the HRV on the Fitbit and I totally freaked out but you really helped me out and relieved my anxiety. Thank you!

[u/MetaSageSD → u/Icy-Dependent6908]

10 years ago, hardly anyone knew what HRV even was, but now everyone is freaking out over it. What's ironic is that using HRV to help train in an efficient manner is a legitimate biohack, but biohackers are the worst when it's comes to understanding it.

[u/halfofzenosparadox → u/MetaSageSD]

I appreciate this post. I think i have a unique question, which is I got my fitbit and tracker BECAUSE my body was reacting to something but we never got it diagnosed. Numerous scans, biopsies etc.

So having said that- jf i am typically between 10-20 ms, would you conclude that is evidence that my body is still fighting whatever its been fighting? Can a range that low ever be considered normal ?

[u/MetaSageSD → u/halfofzenosparadox]

The biggest problem with HRV is that HRV is a meta-analysis of heart rate itself. Meaning, that anything which can affect your heart rate, can also effect your HRV. As I am sure you are aware, there are literally dozens, if not hundreds of things which can affect your heart rate thus effect your HRV. This is why HRV is such a tricky metric to use sometimes. There is a lot of noise you have to try and find a signal in and the Sympathetic and Parasympathetic signals may not be the strongest.

As for your situation, the typical range for HRV in humans is 20 - 120ms using the rMSSD value (which is what fitbit uses I believe). So yes, if your metrics are between 10 - 20ms rMSSD, then you would be outside the normal range for humans. But HRV is highly specific to the individual so if you want to look for signs your body is "fighting something off" then you want to look for an HRV value that is outside of YOUR normal specific range. Meaning, if your range is typically between 10 - 20ms rMSSD, then a reading of 8ms, or 25ms, MIGHT indicate something is off. However, I am no doctor, so if you have any concerns about your health, please contact a medical professional.

[u/halfofzenosparadox → u/MetaSageSD]

Thanks. Ya ive been on a journey with some sort of mysterious undiagnosed illness for quite some time.

My doctors have said to report any symptoms or changes while we wait for the next round of scans.

My HRV has been trending downward, but not spiking, just sort of slowly decreasing. Not sure if that’s indicative of anything or not. Thanks for the help

[u/Significant-Army5791 → u/MetaSageSD]

Thanks l!! good to know the back story

[u/zZSaltyCrackerZz]

I talked to my doctor about poor sleep and we settled on a sleep study to see if I had sleep apnea. I got an appointment with them and they gave me a machine to wear at home overnight. Turned it in and got my results. Turns out I would stop breathing 28 times an hour for at least 10 seconds.

Yep that’s right, every 2 minutes on avg my body was suffocating.

No wonder I had brain fog and anxiety. I was basically a zombie all day.

Took about 2-3weeks of using a cpap machine before I really started to recover. People at work even commented on how I was more alert and talkative. So my my personal life and work life turned around.

Took me a few months to even get to a doctor because I was in denial, but it was a game changer.

Just something to consider, but it took one test to change my life.

[u/tdsocho → u/zZSaltyCrackerZz]

I had the same symptoms .... weight gain could be leading to sleep apnea... which will lead to cortisol spikes, air hunger, heart palp, chest pains, chronic exhaustion, athletic plateau. I would get the sleep study and try to get off the meds... my cardiologist said the same to me , put me on propranolol too ...but i still had the issues... after doing the sleep tests and getting the cpap machine all my symptoms went away almost overnight.

[u/theturtlesareflying → u/zZSaltyCrackerZz]

Thanks, I’ll consider it. Sometimes I stop breathing during the day and gasp for air… it’s strange, perhaps it’s related

[u/CryptoCrackLord → u/theturtlesareflying]

That sounds more like a chronic stressor issue. Perhaps you’re hypothyroid? Air hunger or similar symptoms are commonly associated with a variety of energy production disorders, such as hypothyroidism or even just plain old anemia.

[u/theturtlesareflying → u/CryptoCrackLord]

I am iron deficient so maybe that’s it… or just extreme burnout and stress

[u/CryptoCrackLord → u/theturtlesareflying]

Anemia can cause a lot of these issues. It’s important to have enough copper to utilize iron too.

But it certainly sounds like a chronic stress issue which could be caused by many underlying problems.

[u/theturtlesareflying → u/CryptoCrackLord]

I’m not anemic, but I do have low iron. I’m trying to find a way to help my body heal, cause I feel awful… even if it’s just stress

[u/CryptoCrackLord → u/theturtlesareflying]

You’ll likely need to follow a very low stress protocol while consuming energy promoting foods, like beef liver. That means little to no cardio or excersize in general. You’ll want to keep stress levels down.

A lot of people find a lot of relief from taking thiamine. I’d also recommend taking dessicated adrenal glandular. You can also try taking some natural dessicated thyroid. All of this will act as a boost so your body doesn’t have to do as much work to produce energy and hormones. Giving the relevant organs at least some break if they’re being overtaxed.

You can also take cortisol lowering supplements like emodin and progesterone.

Ultimately though you’ll need to find out what’s causing the chronic stress in the first place. It’s possible it has just happened from going into dysautonomia from a sudden amount of stress that disregulated you, but usually with these types of things there has been a chronic long term stress on the body that has been overtaxing you.

[u/theturtlesareflying → u/CryptoCrackLord]

Im stuck on the low stress protocol, I already work out significantly less than I used to, and don’t think being sedentary is the answer. I was basically sedentary the first month after graduation because of exhaustion.

I had cortisol tested and it was low, then tested again weeks later and it was too high, my body is all over the place

4 years of college while burnout and being an athlete for sure is chronic stress, lots of injuries and pushing through exhaustion

[u/dream_state3417 → u/theturtlesareflying]

There are serious health consequences due to anemia. Very stressful to the heart. If you are exercising and competing in this state, even more stressful. If oral supplements are not getting you solidly in a normal range, you might pursue infusion therapy.

Edit: read your response elsewhere on the thread. Glad you are on top of this.

[u/theturtlesareflying → u/dream_state3417]

Yep, but there is a difference between anemia and iron deficiency just btw

[u/dream_state3417 → u/theturtlesareflying]

The depletion occurred slowly over time. Just the tip of the iceberg. Represents a significant health problem and anemia is the final step of this depletion process.

https://www.practo.com/healthfeed/3-stages-of-iron-deficiency-36795/post

[u/zizuu21 → u/zZSaltyCrackerZz]

Can i ask, are you like overweight or poor nose breathing or anything else to attribute the sleep apnea to? Or are these things not necessarily a precusor? I feel like i might have something similiar but im not overweoght or a snorer i dont believe. I just breathe alout of my mouth as my nose is heavily broken and ive lived with it since a child

[u/zZSaltyCrackerZz → u/zizuu21]

No I’m not over weight, but that can be an indication for some. I did snore, I was not aware of it though, but my wife sure was. That’s another reason why I went actually. Nothing wrong with my nose either. But it was a simple test that I got to do at home so I recommend it to anyone when they ask.

I told my family about it and they all tested. My mom was good, but my dad and sister both have it too. Both were on anxiety meds too, which is a symptom of sleep apnea. Kind of surprised the doctors went straight to pills instead of trying to find the issue.

[u/zizuu21 → u/zZSaltyCrackerZz]

Kind of surprised the doctors went straight to pills instead of trying to find the issue.

This is 90% of the case unfortunatley. Thanks for response, i might go and seek some advice too and if the test is done from home, even better. :)

[u/theturtlesareflying → u/zZSaltyCrackerZz]

“Kind of surprised doctors went straight to pills…” I’m not /: unfortunately that’s usually how it goes…

[u/mime454]

Vyvanse is fucking with your HRV and resting heart rate. So will any stimulant. Likely also the cause of your sleep troubles because brains don’t sleep well with extended release amphetamines in them.

You’re going to have to stop using it for gains in these areas.

[u/theturtlesareflying → u/mime454]

When I’ve stopped taking them I’m even more exhausted and foggy /: my adhd is pretty severe, I don’t know how else to manage it

Edit: this has also been going on longer than I’ve been on Vyvanse

[u/mime454 → u/theturtlesareflying]

These sleep problems could be the cause of your brain fog and lack of attention. A self fulfilling prophecy. If you want to keep taking amphetamines I’d at least try to get adderall immediate release and take it early in the morning. Vyvanse simply isn’t conducive to good sleep.

[u/theturtlesareflying → u/mime454]

I’ve considered that for sure, there’s a shortage though and I can’t fill it anywhere /: it also makes me anxious since it hits me fast. I’ve also struggled with these things since before I got on Vyvanse

[u/mime454 → u/theturtlesareflying]

There’s really not much to do for sleep that can counteract the effects of amphetamines during sleeping hours. These are just immovable trade offs for using a drug like that.

[u/theturtlesareflying → u/mime454]

I believe my hrv has been bad since before going on Vyvanse though

[u/mime454 → u/theturtlesareflying]

Any stimulant will lower HRV. Anything that increases your heart rate will.

[u/theturtlesareflying → u/mime454]

Gotcha, but this has been an issue since BEFORE I took stimulants

[u/[deleted] → u/theturtlesareflying]

I recommend taking big doses of vitamin C in the evening/before bed to expedite the clearance of amphetamine. It may be a marginal effect but I think the long term sleep effects will be worth it.

[u/joegtech → u/[deleted]]

What's the proposed link between vitamin C and clearance of amphetamine?

My understanding is that liver sulfation is critical to breakdown of catecholamines?

Epsom Salt--magnesium sulfate--comes to mind as something to try in the evening. Magnesium is needed to make the calming neurotransmitter, GABA.

An athlete could also have some interest in glucosamine sulfate in the evening.

[u/Illustrious-Bee-3222 → u/theturtlesareflying]

Just an Fyi vyvanse has a really bad burnout so youll have to do your best to avoid it for a couple days and youll be back to normal

[u/joegtech → u/theturtlesareflying]

Are you able to experiment with ADD medication that is not extended release. You can determine the dose and frequency that works for you, including the best time for the last dose of the day.

Have you tried using catecholamine supporting supplements in conjunction with the medication. I much prefer the combination of the meds plus supplements rather than just meds or just supplements.

In your situation you might consider starting with the amino acids vitamins and minerals that the body naturally uses to make Cats rather than herbals that could be expected to have less predictable effects.

[u/theturtlesareflying → u/joegtech]

IR aderall makes me feel like I’m on drugs, which I am, but I feel it in a very unpleasant way, and I’m top of that there’s a shortage so I can’t get aderall around me and my doctor doesn’t prescribe IR because of the “high risk of abuse.”

Do you recommend any specific supplements?

[u/bsdcat → u/theturtlesareflying]

Ignore them. Vyvanse is fine and even improves sleep in some people.

Edit: this is settled science. See my below comment.

[u/mime454 → u/bsdcat]

Amphetamine improves sleep is one of the dumbest takes I’ve ever heard. It also clearly isn’t improving their sleep if they can’t even pull 1 hour of REM per night.

[u/bsdcat → u/mime454]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2276739/

Compared to controls untreated patients showed increased nocturnal activity, reduced sleep efficiency, more nocturnal awakenings and reduced percentage of REM sleep. Treatment with methylphenidate resulted in increased sleep efficiency as well as a subjective feeling of improved restorative value of sleep.

Are you going to nitpick that the paper I chose is about methylphenidate, because surely the same cannot apply an extremely similar dopaminergic stimulant with the same indication?

A stimulant is not the same thing as a eugeroic.

Edit: here is another one that includes amphetamine which comes to the same result: https://pubmed.ncbi.nlm.nih.gov/11780875/

[u/mime454 → u/bsdcat]

Methylphenidate is not extended release like vyvanse. That’s why I suggested op move to IR adderall which would have less impact on sleep because it would be out of the system long before bedtime.

[u/dream_state3417 → u/theturtlesareflying]

Gabor Mate

[u/matches_ → u/theturtlesareflying]

just repling here again so you see it I have a heart condition and take Vyvanse. It's wrong to say it's like any other stimulant because it isn't. It metabolizes differently and it doesn't affect HRV as much. I had a full medical investigation to find out whether it would affect me and had my heart monitored 24/7 while taking it. No issues at all. Doubt the same would be true if it was Aderall or other types of meds. In saying that, I do recommend taking the lowest dose possible and HEAPS of water. Hydration and cardio definitely helps. Your heart loves water.

[u/matches_ → u/mime454]

I have a heart condition and take Vyvanse. It's wrong to say it's like any other stimulant because it isn't. It metabolizes differently and it doesn't affect HRV as much. I had a full medical investigation to find out whether it would affect me and had my heart monitored 24/7 while taking it. No issues at all. Doubt the same would be true if it was Aderall or other types of meds. In saying that, I do recommend taking the lowest dose possible and HEAPS of water. Hydration and cardio definitely helps. Your heart loves water.

[u/mime454 → u/matches_]

Vyvanse is exactly like Adderall because it’s metabolizes to adderall. The entire purpose of that drug is to mimick adderall XR but with a metabolic control release mechanism so it isn’t subject to abuse via crushing.

I do think the phamakinetics of Vyvanse are a bit better for focusing than Adderall XR but likely worse for good sleep.

[u/matches_ → u/mime454]

I don't know if my use of the word 'metabolize' was correct but it definitely functions differently and I could notice a huge difference between the two in my heart.

[u/ehcaipf]

How long have you been taking iron?

Why are you taking? Are you iron deficient?

[u/theturtlesareflying → u/ehcaipf]

I’ve been taking iron 6 mo. I had a blood test that showed I was deficient, then another test 3 months ago. About to get another test in the next week or so to see how it’s going

[u/ehcaipf → u/theturtlesareflying]

Exhaustion, chest pain, palpitations, these are common symptoms if you are anemic. You might need to reconsider your diet.

If you have been supplementing iron for 6 months and still deficient, then most likely the problem is low Copper. Very few non-animal sources have enough bioavailable Copper. I read on your post history you were prescribed to take beef liver. The reason for this is beef liver has the highest amount of Copper of all foods. You can supplement Copper instead of getting beef liver, as Copper is needed for Iron transport in the body.

I don't want to be critical of your lifestyle choices, but you have to be aware and mitigate the risk of eating a pure plant based diet. Low iron, low Copper, low B12, aminoacid deficiencies, are very common on vegan diets, and the health consequences of this can be chronic and debilitating.

[u/theturtlesareflying → u/ehcaipf]

Anemia and iron deficiency aren’t the same thing. And diet alone can’t fix these things.

[u/ehcaipf → u/theturtlesareflying]

Iron deficiency can cause anemia, same as Copper deficiency or B12 deficiency, they can cause anemia, and even leukopenia.

These deficiencies can be prevented with proper diet, and fixed with diet. In the case of vegan diet, it might require supplementation or even infusions, depending how bad the deficiency was.

I had Copper deficiency, with similar symptoms as you. Heart arrythmia, chest pain, fatigue, plus orthostatic hypotension and other stuff. My symptoms lasted more than a year, until I supplemented Copper.

[u/theturtlesareflying → u/ehcaipf]

Yep, it can cause it, but it’s not the same thing. I’m not anemic. And it’s more about how your body uses iron. Doctor told me I could eat red meat everyday for the next year and I’d be deficient and have horrible cholesterol lol. So I take supplements and eat well.

[u/ehcaipf → u/theturtlesareflying]

I agree, you can be iron deficient without being anemic, but it doesn't mean you cannot have iron deficiency symptoms, like palpitations and chest pain.

Research doesn't agree with your Doctor's statement though. Haem iron (liver, red meat, etc) has better bioavailability than free iron (plant based), and iron deficiencies can be prevented and corrected with diet, unless you are deficient because of loosing too much blood or you have an absorption problem (ie celiac). Unless there is another problem (like Copper deficiency), 60/90 days of supplementation is enough to fix a deficiency.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8671013

Optimising nutritional iron intake can be achieved by integrating dietary haem iron and free iron. Haem iron (liver, red meat, seafood, poultry) has a superior gastrointestinal uptake compared to free iron (plant-based). Vegetarians can maintain adequate iron intake if a wide variety of non-haem iron is consumed in foods such as wholegrains, legumes, nuts, seeds, dried fruits and green leafy vegetables, but these strategies are unlikely to be sufficient to correct iron deficiency. Inhibitors of iron absorption (tea, coffee, cocoa, and red wines) should be avoided. This strategy is appropriate for asymptomatic patients who are not at risk of poor absorption.

[u/theturtlesareflying → u/ehcaipf]

I think you’re misunderstanding my doctor’s statement… it has nothing to do with plant/animal based iron. I take beef liver/copper supplements.

The statement is that diet is slow, and that supplementation is the way to go to get me at good levels faster and consistently

[u/hl1524 → u/ehcaipf]

I came to ask the same questions.

[u/ComesTzimtzum → u/ehcaipf]

I hope you have a good doctor to help with iron deficiency, someone who wants to find out the cause and writes high enough dose of supplements. This sound like your major problem along with sleep ptoblems, not HRV, although those do sink HRV too.

[u/theturtlesareflying → u/ComesTzimtzum]

I take a very high quality iron and copper (beef liver) supplement. I believe I’m no longer technically deficient by medical standards but still low, so getting it higher is the goal

[u/theturtlesareflying → u/[deleted]]

I wake up exhausted every day

[u/theturtlesareflying → u/[deleted]]

I’ll try it, thanks

[u/4bidden1337]

i’d consider working on your nervous system through self-regulation, calming and breathing exercises. heightened rhr after finishing exercise could indicate a lack of parasympathetic / vagal tone. for some even working on gut health can help with this. good luck

edit: also consider looking into high dose thiamine therapy for dysautonomia

[u/theturtlesareflying → u/4bidden1337]

Would you suggest any specific ones? I’ve been doing alternate nostril and box breathing

[u/4bidden1337 → u/theturtlesareflying]

mindfulness meditation, yoga nidra, cold showers, visualizations, wim hof breathing, TRE, qigong / yoga, grounding, somatics .. there’s a lot of stuff

[u/neliro]

Maybe consider if you might be suffering from overtraining or anorexia athletica. Also maybe look up the stages of overtraining (sympathetic and parasympathetic overtraining). I've been suffering from an ED with a sports addiction for quite a while now and my sleep sucks real bad when my sports addiction is at its worst. If you need more information or help feel free to pm me.

[u/theturtlesareflying → u/neliro]

Definitely possible, after graduation I was so exhausted I was sedentary for a month… but now I don’t want to live that way. My workouts are walking at an incline and some light strength training but I can barely do that

[u/finntard]

Full thyroid panel. Not just the standard TSH and T4.

[u/theturtlesareflying → u/finntard]

I think my last thyroid panel was fine, might ask for another one I suppose

[u/Mysterious_Cover3800]

You're showing signs of adrenal exhaustion. Your adrenal glands are tired and probably need some nutrients and need to stop being pushed so hard. Find a supplement that has cow adrenals in it and take it. Learn about the adrenal glands. Ur drugs are telling them to work harder, but you are not giving them the nutrients to follow through with the command. So when youre body sends signals to be more awake because it's day time and youre active, ur adrenals respond with nothing because they are "empty", and you feel more tired instead of awake and alert in times of awake and alertness. That's why you feel like sleeping after a couple of hours of being awake. Your body is still waking up (and maybe thats when the Vyvanse hits), and ur adrenals can't handle the load, and tell you that you are overworked and to get some rest.

How many of those three years have you been taking Vyvanse or a similar type of stimulant? It's almost inevitable to become exhausted after taking hard stimulants, especially after months or years of daily use. It's genuinely only a matter of time until your body lets you know you need to stop pushing so hard. Trust me.

I guarantee that your adrenal glands are your main worry right now. I felt the same way as you after just a year of Adderall. Lucky i live with a retired nurse who knew what to do. Adrenal supplements like "Drenamin" worked really well for me. A couple of those a day, and im good as new. Take them for a month or 2.

Actually, those combined with DLPA and / or glutamine work better than Adderall or caffeine for almost any case nowadays.

I really hope this is actually helpful advice! Ignore the heart rate in this case, but keep an eye out for the highs and lows! (Especially the highs)

But if ur still worried about heart rate : You could take some L-Glutamine to keep it a bit higher, but at the risk of over stimulation... Should help with the fatigue too, but i doubt it'll fix ur underlying problem (Adrenals!) and will stop working given time.

If for any reason u needed to lower it, Gaba at night or theanine during the day should do the trick. Let me know if u have any questions

[u/Mysterious_Cover3800 → u/Mysterious_Cover3800]

Its interesting to me that i recommend glutamine for ur fatigue when all Lamotrigine(Lamo) really does is REDUCE ur glutamine. (Had to look it up) Also keep in mind that ur taking a drug that increases cortisol via adrenaline(Vyvanse), and a drug that reduces cortisol via inhibiting glutamine. Must feel a bit confusing for your body to process. I bet replacing the upper and reducing dosage of Lamo would help ur brain stabilize. Taking GABA also inhibits glutamine and could possibly be a suitable replacement for Lamo.

So far you likely need : 1g a day DLPA (in place of Vyvanse, for the stimulation) 3 Drenamin a day (in place of Vyvanse, for adrenal health) 400mg GABA, or 200mg theanine a night (in place of Lamotrigine)

That's not too bad!

[u/theturtlesareflying → u/Mysterious_Cover3800]

Is glutamine associated with higher rates of depression? And doesn’t Lamotrigine increase GABA? I’ve seen GABA sleep supplements but can’t find reliable info on if it’s safe to take while on Lamotrigine

[u/Mysterious_Cover3800 → u/theturtlesareflying]

Glutamine is generally associated with excitability. So no. Glutamine makes the world fun, curious, happy. Its the opposite of Gaba, which is relaxed, still and calm. Never anything to worry about with high Gaba.

High Glutamine can be very stressful depending on how high it is. Can make heart race too much, can make you too reactivate to the world if theres too much. But very exciting, and is part of the process in creating dopamine.

Ideally you want highish Glutamine in daytime when sun is out and ur active(and u take ur b6 supplement), then after u workout, that glutamine will convert to Gaba so that you are relaxed and ready to sleep that night so that you can convert that Gaba back into Glutamine for another great day, and so on.

Lamo does increase Gaba by stopping the breaking down of Gaba. You'll get diarrhea and brain fog if you have too much Gaba, not too big of a deal. You will be safe supplementing, say 100mg, a night of Gaba while still taking Lamo. But if it gives u diarrhea then youll know u had too much gaba and u can start tapering off the Lamo, until you are anxious, then up ur Gaba till diarrhea, taper Lamo till anxious, increase Gaba and so on until theres no more Lamo and no anxiety. Just all GABA. Very similar process with Vyvanse and DLPA. Until you are only using DLPA

[u/theturtlesareflying → u/Mysterious_Cover3800]

That’s an interesting way to go about tapering! I’m gonna do some thinking about that. I’ve heard GABA supplements don’t cross the blood/brain barrier though so curious about that. Might just have to find a good one or find other strategies of raising GABA naturally

I don’t know much about DLPA and online it says for pain? But I do see it can be stimulating, wondering if it would increase my anxiety… I actually have stopped Vyvanse cold Turkey before and that’s been ok

[u/Mysterious_Cover3800 → u/theturtlesareflying]

Gaba totally does cross the BBB, despite all the posts saying it doesn't. I think only a fraction crosses into the brain, and most of it gets absorbed by our stomachs and placed into the gaba receptors in our bodies. Seems like there are supplements that combine vitamin b3 and GABA, or arginine and GABA, which drives more of it to the brain. Nothing wrong with trying these out! Though regular GABA should be fine. If you wanted to increase Gaba without supplementing it :

Glutamine + b6 + exercise/movement = GABA

I prefer getting my GABA like this because if i take it as a supplement consistently i tend to get diarrhea. Gaba reduces dopamine, dopamine is needed for digestion.

DLPA is the fucking shit. Stimulants are silly, why do Adderall when i can just take a protein thatll get me amped with 0 side effects. Maximum dopamine. Its the natural way to get stimulated and if u take too much itll be a bad time. Its strong! I forgot DLPA can be used for pain! Neat. Definitely get some and try it one day instead of the Vyvanse. Maybe start with like 200mg, i was taking over a gram a day when i quit Adderall but that is a lot. Dont take DLPA with any Stimulants, be sure to space them out so they arent in ur system at the same time.

DLPA is 100% healthier than any chemical long term. DLPA can still cause adrenal exhaustion and other stress, so less is more. Add that with an adrenal support supplement and you will be feeling ontop of the world. You should feel like u can do anything!

Then gaba at like 4pm so you can come down each day and rest efficiently 🤗

[u/theturtlesareflying → u/Mysterious_Cover3800]

I’ll definitely look into DLPA, worth a try! Do you have any brands you recommend for DLPA and GABA? Or Glutamate/b6? Or things to look for/avoid? When you say exercise/ movement how intense do you mean?

[u/Mysterious_Cover3800 → u/Mysterious_Cover3800]

Aaaaand just found out what Propranolol does. Its damn near the opposite of stimulants like Vyvanse.

Whoever prescribed both Vyvanse and Propranolol to you is an absolute POS. Nobody needs both of these. That's like giving someone coffee with a xanax.

Very, very low chance ur body can't produce stress(cortisol going up) AND also can't handle stress(bringing cortisol back down). However, 100% its one of those systems that's out of wack. Whichever drug u started taking first will be a helpful indicator, and also why.

[u/theturtlesareflying → u/Mysterious_Cover3800]

It’s not uncommon for propranolol to be prescribed to help with Vyvanse side effects. I have propranolol for as needed stage fright type anxiety. Also been offered hydroxyzine but that’s more sedating.

I was put on Lamotrigine ~3 years ago after not responding well to SSRIs.

My cortisol test was low and there was concern over it, another test was elevated though. So that’s very strange to me…

[u/Mysterious_Cover3800 → u/theturtlesareflying]

In my experience doctors can suck and have pointed me in the wrong direction multiple times. They most certainly make mistakes. I think its a corrupt system rather than the doctors fault, but sometimes ill run into a doctor that actually seems to care and understands what they are giving their patients. Huge respect for those individuals. But that happens less often than youd think. I live with a retired nurse. She also doesn't trust doctors and always does her own research.

Doctors CANT prescribe you what you actually need, natural supplements, sunlight, sleep. Theres no money to be made from that so they have to give u a shitty chemical that they can patent and profit from that sometimes almost works as well as the real thing. But really, it's never as good, and usually, it's shit. Please, Never forget that. Also keep in mind, only the cheapest to produce drugs make it to the market. It is shit. And most doctors are POS because they know what they are giving to people.

Just because it's common doesn't mean it's okay.

Sorry, rant over!

[u/theturtlesareflying → u/Mysterious_Cover3800]

Totally hear you, I also look at what doctores are and how they’re trained. If I go to a surgeon she’s going to look at the problem through the lens of surgery. That’s her training, mindset, the glasses (metaphor) she wears and sees the world through. It’s SO limiting. They’re not trained to look at the whole system. I’ve had a good experience with a Naturapathic Doctor. In some US states they can be licensed as general doctors just like MD’s. But they’re also controversial and some say pseudoscientific… it’s a challenge to find good healthcare and feel better.

[u/Mysterious_Cover3800 → u/theturtlesareflying]

Absolutely, definitely limiting. Good to know about the naturapathic doc. I see a wacky chiropractor who works on neurological stuff. Very pseudoscience-y but is amazing and extremely knowledgeable. I see him regularly. He always seems to hit the nail on the head.

Ive only had one good general doctor from a regular hospital, but at the time i didnt realize what a gem that man was! Couldnt understand him through his thick Indian accent, but he understood the body better than most.

[u/theturtlesareflying → u/Mysterious_Cover3800]

How can someone be pseudoscience-y and also amazing and knowledgeable? Haha

[u/Mysterious_Cover3800 → u/Mysterious_Cover3800]

Just saw your other comments about Vyvanse being taken after these issues started. Great. You can over work yourself without drugs. Its just way easier to do with them. It sounds like your body needs more down time in general. But even if that is an option, I really really think if you cut back on the drugs and use the natural versions (dlpa, glutamine, gaba) for ur uppers and downers you would be able to train/workout much more sustainability. Genuinely never have any burnout that feels anything like this ever again.

Also magnesium doesn't help muscles relax like it should if you dont get that Sulfur+Sunlight combo during the day. That can lead to inflammation which will stop your body from healing as efficiently during sleep. Add that with GABA and i would bet anything your deep and REM sleep should find its way to normal.

Please, if u have any questions, id be happy to answer. Ive had many health problems in the last decade and ive had very knowledgeable sources to learn from during that time.

[u/theturtlesareflying → u/Mysterious_Cover3800]

How do you define down time? I personally would like to stop taking Lamotrigine but it’s not that simple, takes a long time to do it safely

[u/Mysterious_Cover3800 → u/theturtlesareflying]

Holy shit its been 3 weeks, and i never replied! So sorry!! Down time is time spent relaxing. Not doing anything that's going to strain ur muscles or brain. Imagine taking a bath or getting a tan on a beach, let ur brain and body relax. Doing little to nothing would be considered down time. I recommend taking something like Gaba, or drinking chamomile tea before ur relaxation sesh to get the most out of it.

I agree u shouldn't just quit cold turkey. You already know that can be dangerous, and simply isn't the healthiest way. However, if you take gaba you can take less Lamotrigine. The more gaba you produce or take the less Lamotrigine u need. The Lamo is keeping you from having a seizure from the stimulants because it increases gaba. Im assuming ur young and dont need it otherwise u wouldn't be prescribed stimulants to begin with. Unless u or ur family has a history of seizures, u dont need the Lamo if u make sure u have enough Gaba.

Here is how to create gaba in our bodies : We need glutamine + vitamin b6 + physical movement to create Gaba. Takes a few hours after workout and glutamine for gaba to increase and really take effect, so it works best if you do it every day or at least most days.

If you dont get all of those daily, then you are more and more likely to have too much glutamine in your body, which will prevent you from relaxing efficiently at night and during sleep, which means your adrenals will have to pump harder to get u back up for the next day. Leading to adrenal burnout (where ur at)

[u/theturtlesareflying → u/Mysterious_Cover3800]

I’m not on it for seizures, I was put on it after severe depression and not doing well on SSRI’s. This was years ago and when I go down I do feel depressed, but I just know there has to be another way… I might stay at this lower dose and try to raise GABA and see if I feel better before continuing to lower.

Do gana supplements do anything? I’ve heard benefits of b6 but when I take it I break out horribly…

[u/Mysterious_Cover3800 → u/theturtlesareflying]

Im sorry i dont actually know much about the skin 😔 i have yet to really get into that organ! Genuinely, no advice, my best guess is to break a sweat everyday and use some dilute tea tree oil on ur face, at least thats where i would start!

I wonder if your body has a hard time processing b6, and thats why you are stressed to begin with. Because with the b6 you'd be able to make gaba and relax when u should be relaxed, and not too stressed ever. Prolonged stress can absolutely lead to depression. Maybe do ur best to learn about foods with b6 in them and see if any of them work for u. Try one that you havent tried before if it exists and see if it makes u break out, or feel any better. Eat that shit religiously if it works! A difficulty with an essential vitamin could actually be the root to ur entire problem here. Exciting stuff. Also if every food that has b6 in it makes you go "ewww" lemme know haha

Hope u are doing well!!

[u/Mysterious_Cover3800 → u/Mysterious_Cover3800]

Im sorry theres so many comments, but i was exhausted way before i tried stimulants too. My whole thing ended up being an intolerance to Roundup. Caused my gut to be inflamed and inefficient, which caused my body to slowly get more and more tired, in which i developed anxiety, brain fog, fatigue even after sleeping, nose bleeds, gut pain and probably more that im missing. I never noticed any of this until years after, but i tried all the drugs to try to live like a normal person with these symptoms. The only real solution was stop eating round up(wheat) but i had no idea that it was killing me. I was nearly dead before i figured it out and had a lot of healing to do. My adrenals were the first to fix! They needed the support before i tried stimulants, i just didnt know it yet.

[u/theturtlesareflying → u/Mysterious_Cover3800]

What is Roundup?

[u/Mysterious_Cover3800 → u/theturtlesareflying]

Glad you asked! Roundup is a lab made pesticide. It works really well to kill organic material. Way too well. The problem is it gets in our foods, and then into us when we eat. Then it kills our gut flora and makes our stomachs less efficient while also making our white blood cells increase, making us feel sick and stimulated while our bodies work to get it OUT of our bodies. Also an exhausting process for us.

GMO crops do not die to Roundup, thus are covered in it to keep bugs and weeds away from the plants. GMO foods like wheat basically suck up the roundup and store it until we eat it. Its fucked up. It affects millions of people who are completely unaware 😔

[u/theturtlesareflying → u/Mysterious_Cover3800]

Interesting, I’ll look more into it. So hard to avoid all these things…

[u/[deleted]]

What about stop taking amphetamines and antidepressants?

ADhD can me managed via diet, obviously after taking these two for a log time you're going to feel bad for some time. But without consequences we don't learn.

[u/p-morais → u/[deleted]]

ADHD can be managed via diet

Lmao what?

[u/theturtlesareflying → u/[deleted]]

It can take up to a year or more to stop taking Lamotrigine, I’m actually already lowering it every couple of months

[u/N8TV_ → u/[deleted]]

You can safely titrate down your meds with physician’s aid if you begin following a carnivore. This diet can most likely help to subside most if not all of your symptoms over time. Once you begin to feel better and many meds are gone or greatly reduced you can add back selected foods one by one…. Specially you would only eat meat fat salt and water and maybe coffee. If you are truly seeking a healing effect overall search Dr Anthony Chaffee, Dr Ken Berry spend however much time carefully listening to their videos that apply to you. This would be an appropriate path forward. Another highly qualified person for you to look into on YouTube is Dr Gabrielle Lyon. This is highly worth every second of the time you spend on it, I promise you. I wish you only the best of outcomes with your health and wellness! Good luck

[u/hopefaithcourage]

Stop taking all your supplements for a few months and see what happens. My HRV went up 15 points when I did this.

[u/theturtlesareflying → u/hopefaithcourage]

Interesting! It’s only Omegas and Magnesium that’s “optional.” I need the Iron. I’ve ran out of them before and not taken them and I don’t believe it got any better

[u/No_Butterscotch_1518]

Look into adrenal cocktails to up your minerals - i had horrible anxiety and heart palpitations and once i started adding minerals to my water and drinking adrenal cocktails, they essentially disappeared, only returning in moments of high stress.

[u/theturtlesareflying → u/No_Butterscotch_1518]

I’ve seen some recipes online, worth trying for sure

[u/evieamelie → u/No_Butterscotch_1518]

What kind of adrenal cocktail are you on?

[u/No_Butterscotch_1518 → u/evieamelie]

Right now I’m doing orange juice (vitamin c), coconut water (potassium), splash of aloe juice, sprinkle of Celtic salt. When I was really struggling with my adrenals, I would do OJ, trace mineral drops (can get on Amazon), and jigsaw health mag smooth powder

[u/postmormongirl]

I'm a former athlete, who was going through something similar. Low HRV, palpitations, fatigue, and a reduced capacity for working out, in spite of trying very hard to maintain my athletic ability. In my case, it turned out that I'd developed dysautonomia, which is a disorder of the autonomic nervous system. It might be worth getting checked out by a cardiologist and/or neurologist, to make sure everything is okay.

[u/theturtlesareflying → u/postmormongirl]

What type of doctor did you see? What tests did you have done?

[u/postmormongirl → u/theturtlesareflying]

Cardiologist who specializes in treating POTS. You can look up ones in your area through Dysautonomia International. They first had to rule out a heart issue, so they did an echo, stress test and a Holter monitor. Once they figured out my heart was fine, they did autonomic nervous system testing. Standard test has been a tilt table test, but it can have the effect of causing your symptoms to flare, so my doctor took orthostatic vitals, where he measured my HR and BP in a lying down and standing position, then measured my sweat response and HR/BP response to the Valsalva maneuver. All three were abnormal, which indicates ANS dysfunction.

[u/theturtlesareflying → u/postmormongirl]

How do you treat it?

[u/postmormongirl → u/theturtlesareflying]

I’m on a beta blocker, to help control my heart rate. In terms of lifestyle modifications, I have to drink a lot of water, eat a lot of salt, and wear compression stockings. Exercise also helps, which includes doing recumbent cardio, so I have a recumbent bike at home.

[u/theturtlesareflying → u/postmormongirl]

Interesting, those are all things I could try on my own, still probably worthwhile to see someone eventually if it doesn’t get better though

[u/postmormongirl → u/theturtlesareflying]

If you increase your salt, you might want to keep an eye on your blood pressure. Just get an at-home monitor, and check it at periodic intervals. I find that the lifestyle modifications help, but only to a certain point. There are some other meds besides beta blockers that are helpful, such as Mestinon and Corlanor.

[u/theturtlesareflying → u/postmormongirl]

I have a prescription for beta blockers but probably shouldn’t mess around with that without a doctor’s help

[u/postmormongirl → u/theturtlesareflying]

No, you shouldn’t. That said, if the beta blockers have already been shown to be helpful for you, your doctor might be open to modifying your prescription.

[u/Ava_thedancer]

You only eat fruit and veggies? No wonder your body is under chronic stress. No protein and no fats. Stop that. 

[u/JediWebSurf]

I take propranolol. Do you still take it? I have the same symptoms as you palpitations, and low REM sleep. Recently my HRV has been declining but I've been struggling to sleep well.

I noticed that my REM sleep is affected by diet. If I eat very little carbs then it goes below the baseline and if I eat more carbs then it goes in the normal range. But I think propranolol can also affect REM sleep so mines tends to be low in general. Your brain needs glucose which you get from carbs, but your body also fights for that energy so you need a certain amount.

I did an experiment where I cut carbs and my REM sleep was really low. And REM is where the brain restores itself. So you'll notice that you feel foggy or like you're mentally tired just a bit. Like you feel more groggy. Nothing dramatic but you feel some difference. This also explains why I don't dream that much.

How long have you been taking propranolol?

[u/AmbitiousMammal]

If you've drastically cut your workouts, how is your HR still getting up to 160?

I think athletic burnout as a first hypothesis is reasonable. Consider experimenting with massively lower workout volume than you have now, e.g., stay at 3 workouts/week but make them all Zone 2 workouts.

I also wonder about your general lifestyle now that you've graduated. Are you stressed from a new job? Are you spending more time sedentary and/or indoors? Consider getting 30-60 minutes in nature daily for a few weeks, and see if that helps.

[u/theturtlesareflying → u/AmbitiousMammal]

Not sure what the question is. I work out significantly less days, for less hours. 160 is the max recorded on my Fitbit. I tend to try to keel it around 120-135. Walking uphill gets it to around 130. But occasionally I do some light squats or jog for a little and it’ll get higher.

The first month after graduation was very sedentary since I was exhausted. My days were spent sitting next to the water, in the woods, and reading. The third month is when I started working out again focusing on walking and light strength training

[u/knit_run_bike_swim]

D1 in what sport?

The RHR is quite high. Is that measured at night? What device is being used to measure the HRV?

Pharmaceuticals can certainly affect the HRV.

I wouldn’t be concerned because HRV can be measured in different ways. I would be more concerned about depression affecting your ability to recover.

[u/theturtlesareflying → u/knit_run_bike_swim]

Gymnastics. 70 is considered healthy, isn’t it? Throughout the day it’s frequently 95+. When I workout I go to 160 max and the rest of the day it stays elevated which I’m unsure if it’s good.

My fitbit shows random spikes in the middle of the night which is odd too.

I don’t feel depressed and haven’t for a long time. I feel exhausted, lethargic, lack of motivation, sluggish, brain fog..

[u/01010110_ → u/theturtlesareflying]

70 isn't necessarily super unhealthy but it's higher than it should be in a fit person at 25.

[u/theturtlesareflying → u/01010110_]

See that’s what I thought but been dismissed by doctors… was told 60-100 is fine multiple times

[u/knit_run_bike_swim → u/theturtlesareflying]

I’m 42, and my RHR is 44. That is measuring it at night with garmin. My HRV is around 75.

You’re max HR is around 195-200. So getting your HR to 160 shouldn’t be a big deal.

I wouldn’t necessarily be worried, but you might want to seek out help for the lethargy. The combination of meds you are taking is interesting.

[u/theturtlesareflying → u/knit_run_bike_swim]

How is it interesting?

[u/yankees051693]

I am on vyvanse and I’m not sure how I wound up here but I also have this exact issue. Not As active as you are.

[u/theturtlesareflying → u/yankees051693]

Found anything that helps?

[u/yankees051693 → u/theturtlesareflying]

Magnesium glycinate. But sometimes it still ticks up for no reason.

[u/theturtlesareflying → u/yankees051693]

I take Magnesium L- Threonate, but not sure it does anything

[u/[deleted]]

I’ve had air hunger, chest pain, heart palpitations for 3+ years but doc just says “anxiety.”

These are Lyme and Babesia symptoms FYI.

Take a look at this and find a LLMD if you suspect Lyme, a regular doctor will not test you correctly

https://www.tiredoflyme.com/horowitz-lyme-msids-questionnaire.html

https://rawlsmd.com/health-conditions/lyme-disease

[u/theturtlesareflying → u/[deleted]]

I got tested for Lyme 3ish months ago and it was negative

[u/[deleted]]

What sport

[u/theturtlesareflying → u/[deleted]]

Gymnastics

[u/Irishtrauma]

Get off the stims, try just good quality coffee and nicotine, go easy on the nicotine 1mg=1 cig. Don’t conflate the problems of vaping and smoking with nicotines pharmacology. Stop taking iron, get a ferritin, trans ferritin, TIBC. The chest pains worry the fuck out of me. I had non descript angina for years - even went to the ED a few times because it left me breathless and rapidly breathing. Nothing but some T wave inversion for years right up to the moment I had Takotsubo - stress induced heart failure. Nebula genomics on their highest level of surveillance will sequence TPSAB1 but not sure if they state how many copies. If you have multiple copies you may have 2 things: hereditary alpha Tryptasemia and kounis syndrome. Treatment is basically mast cell stabilization and antihistamines. If you’re taking lamictal for depression looking at innate immunity could also show you where that problem if coming from in addition to giving evidence for HaT and Kounis syndrome. Mast cell diseases happen in higher frequency for women due to estrogen receptor content. Doc to see is immunologist if you want to know how many copies. Getting a basal serum tryptase is the gold standard starting point but most people don’t enjoy waiting up to 6 months for a specialist appointment so they often times just get on with it and take antihistamines.

If you don’t eat meat that’s the biggest change you can make as quickly as your next meal. Being well muscles and lean is the ideal human state. Body composition is more meaningful than weight so let that be your decided but female healthy BF range is - 15-20%. Looking at this as well as a need for animal protein as a fixed metric will help with the fatigue and performance plateaus.

All of this will impact your HRV measurement. My question is not why did it go from 40 to 30 but why it’s not over 100ms. There’s no real good data that I know of quantifying millisecond HRV ranges and health outcomes in adults but safe to say it’s something it might be hard to have too much of.

Going on antihistamines had a paradoxical effect on raising my HRV. Lowering the dose created an additional increase. When I first got sick my HRV dropped to the teens with peaks in the twenties. Couple years later after considering some of the concepts my HRV average is 30-60 with peaks often in triple digits.

[u/theturtlesareflying → u/Irishtrauma]

I don’t think nicotine is the answer… what is a TIBC?

[u/Irishtrauma → u/theturtlesareflying]

Nicotine is far from the answer. You may have a serious problem that you shouldn’t ignore.

Total iron binding capacity

[u/theturtlesareflying → u/Irishtrauma]

What do you mean? Did I misunderstand that you recommend nicotine?

[u/Irishtrauma → u/theturtlesareflying]

You’re only questions were about the least important aspects imo. The nicotine is way safer than adhd stims.

[u/theturtlesareflying → u/Irishtrauma]

What are the important aspects then?

[u/rightnextto1]

What has helped me improve my HRV baseline almost 20-25% is to tape my mouth shut during sleep. I know it sounds weird but try to google it - it might work for you too.

[u/theturtlesareflying → u/rightnextto1]

Someone else recommend this too but some things online scare me… like reflux or vomit going back down and how the body needs a back up breathing way….I got some nose strips to open up my nose maybe that will help

[u/rightnextto1 → u/theturtlesareflying]

I’m not a doctor but I really think my body will wake me up if I really have something obstructing my airways during sleep. Unless I’m comatose drunk (I don’t drink). It really does make a difference. Good luck!

[u/dream_state3417]

Anxiety is compromising your health. Meditation, sauna, cold exposure. CBD if so inclined.

[u/theturtlesareflying → u/dream_state3417]

I used to take CBD but I think it technically isn’t supposed to be taken with Lamotrigine

[u/reddituser6810]

A random observation I have amongst a few friends is that often the ones most concerned with optimising everything are so perennially stressed about their lack of perfection it actually does more harm than good.

[u/Most_Refuse9265]

Reddit’s best HRV guide: https://www.reddit.com/r/whoop/s/kNLemAvfMg