Ep. 231 - What Your HRV Score Reveals About Your Immune System, Chronic Pain, and Brain Health
Heart rate variability has become a buzzword in wellness circles — but what does it actually measure, and why does it matter far beyond fitness tracking? Rheumatologist Dr. Andrew Holman, associate professor of medicine at the University of Washington and founder of InMedix, joins Dr. Dean Mitchell to explain how HRV serves as a precise, measurable window into the autonomic nervous system and what that means for immune function, chronic disease, and personalized medicine.
Dr. Holman breaks down the difference between consumer wearables and his FDA-cleared cloud HRV device, which uses a five-minute EKG sampled at 500 times per second to accurately measure both sympathetic and parasympathetic activity against clinical standards — not just comparing you to yourself. He shares how a prospective double-blind study using advanced HRV predicted with 90% sensitivity which rheumatoid arthritis patients would respond to biologic therapy a full year in advance, and how addressing autonomic imbalance raised remission rates from 25% to 79% in a pilot study.
The conversation covers the autonomic roots of fibromyalgia, the overlooked role of sleep apnea in autoimmune disease, positional spinal cord compression as a driver of chronic pain, and the concept of immunoautonomics — a framework Dr. Holman introduced to the medical literature describing how the brain's command and control center influences immune function in autoimmune disease, cancer, and infectious illness. Dr. Holman also discusses the legacy of Dr. Kevin Tracy's vagus nerve research and how it intersects with his own work measuring autonomic state at its source.
For patients and physicians alike, this episode makes the case that measuring HRV with clinical precision is as essential as checking cholesterol — and that the future of medicine depends on understanding who each patient is autonomically before deciding how to treat them.
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