Show Notes
Unstress HEALTH podcast – Dr Torkil Faero: The Pulse Cure
Unstress HEALTH podcast – Dr Leland Stillman: Light Therapy, Circadian Rhythms & Melatonin
Unstress HEALTH podcast – Patrick Holford: Food for the Brain
Timestamps
00:00 – Introduction to Dr. Andrew Ahn
05:15 – The three hats Dr. Ahn wears in medicine
07:32 – Integrating tech and holistic health
14:47 – The science of acupuncture and bioelectricity
26:39 – Chaos theory and non-linear systems in health
42:41 – Role of wearables in modern healthcare
48:09 – Citizen science and empowering individuals
58:56 – The biggest challenge in modern health
Dr Andrew Ahn on Integrative Medicine & Wearable Tech
Dr Ron Ehrlich [00:00:01] Hi, Dr Ron. Here it. I want to invite you to join our Unstress health community. Now, like this podcast, it’s independent of industry and focuses on taking a holistic approach to human health and to the health of the planet. The two are inseparable. There are so many resources available with membership, including regular live Q&A on specific topics with special guests, including many with our amazing Unstress Health Advisory Panel that we’ve done hundreds of podcasts over listening to with some amazing experts on a wide range of topics. Many are world leaders. But with membership, we have our Unstress Blab podcast series where we take the best of several guests and carefully curated specific topics for episodes which are jam packed full of valuable insights. So join the Unstress health community. If you’re watching this on our YouTube channel. Click on the link below or just visit Unstress health.com to see what’s on offer and join now. I look forward to connecting with you.
Hello and welcome to Unstress. My name is Dr Ron Ehrlich. Well, today we cover a wide range of topics. We revisit what integrative medicine means. We talk about the electrical properties of human tissue. We talk about wearable sug, wearable data, the information that we can gain, understanding the evolution of energy and how it affects us, how it drives our body. My guest today is Dr Andrew Ah, and Andrew is an intern. He wears many hats. He’s an internal medicine physician with a background in physics, engineering and physiological signal analysis. Now, while that may sound like a mouthful, it’s something we should all be interested in because it just happens to be the way the body works. Andrew is an assistant professor at Harvard Medical School and a chief medical and science officer at the lab front. Now Leap Front is a Start-Up revolutionising health research by helping academic researchers efficiently collect and analyse biomarker data from consumable wearables and the Internet of Things devices. That’s how devices connect with other devices and collect information across a wide range of platforms. Now, nearly a thousand researchers from 50 plus top institutions, including Stanford, M.I.T., Harvard, Duke, Dartmouth, US de USC, UC Berkeley and Yale. Big names use lab front to accelerate their endeavours to their endeavours to optimise human performance, fight diseases and advance the human race. They have partnered with leading health device market makers like Garmin.
Now, you may recall the episode we did with Dr Torkel Ferro on the Pulse Cure, and he was talking very much about Garmin. Garmin has been using technology for over 20 years, and I’ve had all the different devices. I’m not doing a commercial here for Garmin, but he was recommending Garmin. And here we have Garmin. The name again. Andrew is passionate about using mathematical and computational analysis to understand the physiological data that we all limit. Things like heart rate, blood glucose level, respiration rate, body temperature and HIV heart rate variability. And we talk about that as well, and all of that to help develop new medical treatments. You know, what I found most inspiring about Andrew is his drive to pursue more knowledge. I mean, given everything he knows, he’s out there always exploring more. And he’s taken many graduate level courses in biological engineering at M.I.T. as an advanced study fellow. Now to the curious mind. As I’ve said before, the more you learn, the more you realise you don’t know. And that is rather exciting and empowering and always drives you to learn more. Now I wish more medical practitioners had that attitude, but they don’t. But Andrew is definitely an inspiring character and this is an absolutely fascinating episode. I hope you enjoy this conversation I had with Dr Andrew Ahn. Welcome to the show, Andrew.
Dr Andrew Ahn [00:04:47] Thanks for having me.
Dr Ron Ehrlich [00:04:48] Andrew I’ve been so looking forward to this conversation because I know you’re into the tech of healthcare, the potential there. I know you’ve also been very interested in integrative medicine, which is something we’ve explored on many occasions. I wondered if you and you wear several hats, which we were talking about just before we came on. I wondered if you might just share with us those three hats that you’re wearing now.
Dr Andrew Ahn [00:05:15] Yeah, I’d love to. And thanks for having me. By the way, Dr Ron.
Dr Ron Ehrlich [00:05:19] The pleasure.
Dr Andrew Ahn [00:05:20] So one hand, I swear I am the chief medical officer for a Start-Up called Laugh Front. And in this role, I sort of guide the vision and the research that is involved in the data that you collect from consumer wearables, including Garmin and other devices. The second hat I wear is that I am the leader or the director of the high tech soft touch Integration at the Offshore Centre for Integrative Health at Harvard Medical School and the Brigham Woman’s Hospital. And the third hand I wear is that I’m a hospitalist, basically an internist taking care of sick patients admitted to the hospital at the VA Boston Medical Centre.
Dr Ron Ehrlich [00:06:02] Wow. So that means that you are actually seeing real life patients and applying so much of this theoretical technical stuff to real life patients.
Dr Andrew Ahn [00:06:13] Well, it’s really hard to integrate. So, you know, speaking of the challenges of bringing in tech and even some of the integrative health practices into conventional medicine is always a challenge. And so that’s that’s one of the frustrations that I’ve encountered as a physician, is that it’s hard to implement these things just because there’s a lot of barriers that you encounter, you know, in terms of data acquisition. For instance, in my role as a chief medical officer, I analyse a lot of data that you get from consumer wearables such as garmin’s, move sense, etc., like and, you know, the ability to acquire that data in a clinical setting, particularly in a hospital, is challenging, you know, with hip and all that.
Dr Ron Ehrlich [00:07:00] I mean, I mean, one of the things about Western medicine that we’ve often said is thank goodness for Western medicine, because when you really need it and the hospital, I’m assuming by the time they come to the hospital, it’s a crisis and they really need Western medicine. But there’s something about the integrative approach which tries to intercept that process, doesn’t it? Tell us a little bit about your interest in integrative medicine, which must contrast with your work in the hospital quite dramatically.
Dr Andrew Ahn [00:07:32] Yeah, no, I’m sure there’s a lot of internal conflicts happening to me, if you could imagine. Yeah. Yeah. When I first applied to medical school, I was actually at that time interested in traditional Asian or Chinese medicines. I didn’t have much experience with it. My parents actually didn’t use much of it. But for whatever reason, the the idea of Chee and energy, the idea of balance and yin yang, it just really appealed to me. And so when I applied to medical school, I was thinking that there was this opportunity to explore some of that concepts in in medical school. But sure enough, I never had that opportunity. And somewhere along the line, so I ended up going to medical school at New York University, did my residency at the University of Michigan in internal medicine, and then decided somewhere along the way that I wanted to sort of branch out and get into integrative health. And at that time, there was a there still is a general medicine complementary alternative medicine fellowship at Harvard Medical School. It’s a fellowship. It’s a postdoctoral fellowship. It’s a three year program. You get an MPH at the Harvard School of Public Health. And I decided to join that. And I focussed on studying acupuncture just because I just felt that there’s a lot of these concepts that I was, you know, I considered missing. And when I was practising or seeing in the sort of hospital.
Dr Ron Ehrlich [00:09:09] And acupuncture is an interesting one, isn’t it, Because when it first found its way into health care. Well, I mean, it’s been in health care in China for many, many years. But in Western medicine, it was initially viewed with a great deal of scepticism, wasn’t it? I mean, with the swears, the science would be the the throwaway line. But you’ve explored that to establish there is a science.
Dr Andrew Ahn [00:09:34] Yes. And in fact, out of all the integrative Health SA therapies, I mean, I started my fellowship back in 2002. So you could imagine it was a different time. You know, these integrative health therapies were considered very fringe. But even then, acupuncture was considered a little bit more mature due to the research studies that were done in rat studies and the specific mechanisms that they identified where the opioid sort of the opiate mechanisms, the sort of the mechanisms that was done by Bruce Pomeranz in, in Canada. Zhisheng on, in, in China. They did these extensive research in the endogenous opiate systems and found out that acupuncture in mice and rats really stimulated the endogenous opiate systems. And there was like, you know, at least 17 different converging evidence to implicate the endogenous opiate system in the effectiveness of acupuncture. And so that sort of carried a lot of weight. And that was done in the 1980s, 1970s and 1980s. So that carried a lot of weight then. But, you know, I think when it came to extending the the application into the real clinical situation, like seeing patients, etc., there was still some insufficient data. And I thought there was I think that was an exciting time to see what could be shown about the efficacy of acupuncture in multiple chronic conditions.
Dr Ron Ehrlich [00:11:10] And you mentioned the endogenous opiate system. Just explain that a little bit more to our listener.
Dr Andrew Ahn [00:11:15] Yeah. So, you know, the body releases a number of endogenous opiate systems. If you I’m sure you’ve heard of endorphins and cephalopods. It’s it’s you know, if you’ve heard of these endorphins that are released, you know, I’m sure you’ve heard of the sort of the the artificial opiates that we use in terms of pain suppression. But the body has the ability to produce it indigenously. And for whatever reason, it tends to be released in stressful conditions and in times when there is pain. And acupuncture was considered as a type of, I guess, well tolerated stress to certain parts of the system that activated various nervous pathways, that caused the release of endogenous opiate systems in the brain and also at the spinal level as well. So I think hopefully that addressed a little bit of your question. Yeah, I.
Dr Ron Ehrlich [00:12:18] Think it’s interesting to use the word this tolerable stress because we’ve explored intentional stress or mazes on various programs, and I’ve never really thought of acupuncture in that in that sense of an intentional, well-directed stress to the body at particular meridian points.
Dr Andrew Ahn [00:12:40] Yeah. What is very interesting actually, and this is still an area of study, was that the way they administered these needles or interventions in mice and rats were quite significant and actually were considered painful because some of the mice would shriek. And the reason a lot of the studies used electro acupuncture and the the type of stimulations they administered was in many cases in the middle apse range. So these are quite intense. And and interestingly, that intensity was not specific to like the the needles were not necessarily specific to an acupuncture point. You could put it in any skin region and then activate it simply through this pathway of causing sort of a significant stress and then activating the endogenous opiate system.
So, you know, when it came to human studies, there was a concern whether these mice studies, which were, you know, significantly stressful for the mice, could be extrapolated to human studies or to the human case. And so even to this to this to this day, we don’t truly understand how acupuncture, particularly some of the minimal things like the the low intervention, very low light, certain styles like the Japanese style, just has very little stimulation of the needles. And in fact, some of them don’t even penetrate the skin. And the question is, what are they doing in those styles? And and we’re not entirely sure, but I learned to the Japanese style when I was also doing this fellowship. And what intrigued me was this idea that you could deliver these very low intensity, sometimes non-contact interventions and you still see some therapeutic effects. And so that got me very interested in alternative mechanisms other than even the nervous system. And that got me down into the electrical mechanisms of these interventions.
Dr Ron Ehrlich [00:14:47] Which kind of raises the point, doesn’t that I mean, I’ve been interested in integrative health for over 40 years and I’ve always thought know sleeping and breathing a foundational, you know, nutrition, environmental medicine, important. But over the last 5 or 10 years particularly, I’ve come to realise and many people talk about the metabolic nature of disease and particularly mitochondrial function. Which leads us into the whole realm of quantum biology. And and we start to think about ourselves as walking electricity. You mentioned milliamps, which in a body sense is is quite an intimate. I think we function on is a true micro amps or nano. I mean, what is body electricity? How do we measure that in an image?
Dr Andrew Ahn [00:15:38] That’s a great question. There is it’s really unclear in terms of the intensity of the current we’re talking about. But, you know, there are a range of therapies that are out there that are believed in sort of low intensity, micro amp current stimulation techniques. And the idea is that these low intensities, you shouldn’t even feel it, but these low intensities are sort of accessing this electrical system that seems to be more sensitive, ah, to these low intensity microcurrent compared to the higher intensity currents that you see. For instance, in tense devices, you know, the tens devices tend to be pretty strong. And interestingly or curiously, the tends devices came out of a lot of the acupuncture related studies that were done by Bruce Pomeranz and Jang Hahn. And those studies, as I stated before, used high intensity electrical stimulation. But, you know, I think the mechanisms through which these microcurrent interventions and how it affects the body aren’t entirely clarified yet. And I think that’s an area of interest of mine. And I still think it’s a mystery to many.
Dr Ron Ehrlich [00:16:54] And you mentioned the Japanese form of acupuncture, which is even lower intervention. It kind of suggests that there’s energy within our cells in our body, but that energy radiates beyond our body and things can influences that don’t necessarily even touch our body. I suppose a good example of that would be the sun. yeah. You know, we don’t we don’t come into contact with the sun, but it is undeniably an important factor in our health. So maybe not surprisingly, something of low touch. You must have given a great deal of thought to how this Japanese acupuncture and it’s not you say it’s not entirely clear, but I imagine, Andrew, you’ve you’ve got your own hypotheses on this and I’m not going to hold you to a randomised double blind controlled trial. We’re not in a scientific community yet. I’m just intrigued to know if you were shooting the breeze, what some of your thoughts were on how this all worked.
Dr Andrew Ahn [00:17:55] Yeah, I have a number of hypotheses, some of which, you know, I would love to pursue still. But you know, at the time what I had done was I was really interested in the electrical properties of these meridians and points. Now, if indeed this low intensity, low intervention acupuncture points were accessing some system electrically, then I thought that there had to be some kind of electrical pathway that operated in the body. And, you know, there was some early studies done by Robert Becker in the 1950s and 60s that sort of had this idea of these para neural pathways that wasn’t exactly in the nerves itself, but the possibly the myelin sheath or the pair neural cells that are around it. And that led me sort of down a rabbit hole of trying to understand what are the electrical pathways that could exist outside of the nervous system.
And there is a few that came to mind. The first thing is the connective tissue system, the fashion. I’m sure you’ve kind of learned in your multiple interviews that you’ve had in the past, and the fashion is basically the fabric that keeps the body together. It’s the in it’s the lining of the organs. It’s it’s basically all the components that keep structure in our body. And the most common protein within the connective tissue is type one collagen. And collagen, interestingly, has a lot of interesting electrical properties. It’s, first of all, crystalline. So if you take a look in the microscope, collagen is lined side to side, head to tails. And it has these crystalline characteristics. And because of this crystalline characteristics, it has what’s called piezoelectric properties. If you press on it, if you stretch it, it generates an electrical polarisation on the surface. The other thing it has is it has higher electricity. So if you apply heat, it also generates electrical charge on it. The other thing is that it is sensitive to certain laser or certain light frequencies of light. And generates something called second harmonic generation. And it’s a way that certain microscopy techniques are used to actually assess connective tissue within the body. And I think I forgot the specific frequency, but two photons going to a collagen molecule will be absorbed and then that cauldron will release a third marker, which be the sum of those two photons. So basically twice the frequency, so twice the energy. And so this the second harmonic is used then to image collagen. And so if you put it together. And the other thing is because of the crystalline nature, collagen has also on its surface charges and water could theoretically be more ordered on the surface of the collagen. And because water is more ordered, you could possibly have what’s called protesting. So protons travelling along the line of the water on in an organised were parts of the collagen. And when you think of all the various characteristics of collagen, you could understand how some of the interventions that acupuncturists use sort of correlate with the properties of these, this electrical properties of content. So the electric property, the fact that you have mechanical pressure generates electricity can account for acupressure.
The second thing is power. Electricity, if there’s no heat, generates electrical polarisation or charge it, they use moxa. So like you apply herbs or any type of heating, right at acupuncture points. The third is at that time they were using laser acupuncture. So the second harmonic imaging may potentially account for why laser. It could be therapeutic. And then the fourth was this. This travel of protons along this collagen chain could explain for electro acupuncture. So you had all these things that could sort of put all these things together. And at that time, also around 2000. Yeah, around 2000, five, 2006. There are some great study done by Alan Large, Yvonne, who right now is the director of the National Centre for Integrative Health at the NIH right now. She was my mentor and at that time she found that acupuncture points and meridians were located over inter muscular fascia. So if you take a look at four inches the pericardium Meridian, the pericardium meridian is not exactly over muscles, but between the muscles where the fash are located and putting it all together, you have basically points and meridians located along these fascial plates where you’ll find more connective tissue. Connective tissue will have a lot of collagen in this. Collagen would be organised and it will have these bioelectrical properties that that can account for how small interventions that the acupuncturists are using are having sort of this body wide effect. And since interest, since collagen is basically all over our body, it is the faster also lines, the organs and lines, the nerves and lines, the vasculature. You have a whole system that could ideally be a circuitry, a very complex circuitry by where these these electrical signals are communicating within your body. So that was one area that I was very interested in evaluating. I have another hypothesis, but I don’t want to take too much time.
Dr Ron Ehrlich [00:23:56] No. Well, I don’t want you you know, this is part of the problem. I, I don’t we get bogged down or some people get very bogged down in. Well, I don’t want to say anything unless there’s a double blind randomised controlled trial to support what I’m saying. And I often felt that rather than go back and study a do a Ph.D., I know you’ve done a Ph.D., but if I you know, if I had a choice, I used to think I would go back and study anatomy, physiology and biochemistry again after all these years of clinical experience. And it would make so much sense. But now I realise I need to go even further back. I need to go back and study physics and chemistry at a molecular and an atomic at the atomic level. You mentioned Becker, who I know wrote that fabulous the very important book, The Body Electric. And you mentioned collagen having crystalline nature. There’s also something about water, too, isn’t there, which has this fourth phase of water, which is part of this subtle energy response the body is capable of. What are your thoughts on that?
Dr Andrew Ahn [00:25:04] Yeah, No. And in fact, was it Gerald Pollack?
Dr Ron Ehrlich [00:25:08] Yes. Gerald Pollack’s the fourth phase of water.
Dr Andrew Ahn [00:25:12] Yeah. When when his work came out, I truly felt that there was something there. And in fact, even before Gerald had talked about, there was a acupuncture researcher by the name of May 1st ho who sort of suggested this liquid Crystal Lin aspect of collagen and possibly its relationship to acupuncture. She also had talked about order to water and its propensity or its ability to have these interesting electrical properties. And so, yeah, I think there’s a lot there how to evaluate that in in vivo in real world settings and seeing how, you know, it’s hard to imagine how you would sort of create a study to evaluate whether these the fourth order of water is, is somehow implicated in in your overall health. So I’m always curious to see how we can sort of explore this in the future, but I am a believer in it.
Dr Ron Ehrlich [00:26:16] Yeah. Now what another area that I know that you are interested in is nonlinear dynamics systems. And I and I, when I read that, I thought, well, are we talking about here a reductionist approach to health and a more holistic approach to health? Or what what is what what does nonlinear dynamic systems mean? What does that mean to you?
Dr Andrew Ahn [00:26:39] Yeah. So what what happened was that I think during my fellowship. As part of the MPH at Harvard School of Public Health. I had the opportunity to cross register for a number of classes at MIT and at MIT. I took a course in Chaos Theory and nonlinear Dynamics. I was just fascinated by chaos theory because it just sounded cool. And I think at that time there was a book Freak out by Clique, I think, that sort of talked about chaos, theory, theory.
Dr Ron Ehrlich [00:27:15] Just remind our listener about chaos theory. No one.
Dr Andrew Ahn [00:27:20] Yeah. My goodness. So chaos theory. It came out actually, a lot of it came out of Lawrence by MIT, who was an MIT professor who tried to understand sort of the properties of sort of natural systems. He was specifically interested in the weather. And he he studied he had this sort of mathematical representation of what could happen in certain weather conditions, you know, like where you have pressure that leads to temperature changes, etc.. And it was that three equation problem. And he found out, interestingly, that out of this very simple three equation problem, you could see some very unusual dynamic characteristics that, you know, as you, you know, put on the computer, you could see that it had these very interesting patterns. First of all, it has what’s called sensitivity to initial conditions. So if you for its is the idea of the butterfly effect, right? If you if you change the initial conditions just a little bit, those initial conditions, then subsequently, you know, it could be, you know, .0001. And the difference in the temperature of this representation of the weather and that 0.00001 difference in the temperature would magnify over time. So that by the time, you know, maybe minutes afterwards, the system will look completely different than the one that was just, you know, almost nearly identical but was just a little off. And then the other thing that they found out was that there was sort of this idea of attractors that you the system has this ability to while have, you know, like diverge a lot. They would still sort of come together at this very similar pattern. And it has like this actually this butterfly appearance when you do sort of this this phase plot, when you combine those things that chaos there was understanding that out of very simple systems you could get very complex patterns. And the reason you get complex patterns is that you have feedback loops within it so that you have iteration. So one thing subsequently affects the other. And then that iteration is non-linear. So it’s not like one, you know, if you double it for one variable, it doesn’t necessarily double another variable. And in fact it could be exponential or it could be note. And as a result of that, you have these very complex patterns. And so that was sort of the idea. This idea of chaos theory is, is is basically very complex patterns coming from a very simple system. For me, I was very interested in at that time what was complexity theory, This idea that you get a lot of sort of very interesting patterns based on multiple parts, like a very complex system interacting with each other in a nonlinear way.
You know, you can think of sort of the genetic network or you could think of the protein network. There are many, many different pieces that are interacting with each other, much of it nonlinear in a nonlinear way. And out of that manifests some very interesting patterns. And so that’s kind of how I got interested, because I felt that system, this chaos theory partly, but also complexity theory, was capturing some of the things that traditional Chinese medicine and also other ancient medical therapies were discussing about the idea of balance, the idea of fractals, the idea, for instance, that the ear could represent the whole body or the or the foot, the reflexology could represent the whole body. All these things actually came out of sort of complexity and chaos theory. So, I mean, that’s why I was really just saying.
Dr Ron Ehrlich [00:31:34] Dr. on here it. I want to invite you to join our Unstress health community. Now, like this podcast, it’s independent of industry and focuses on taking a holistic approach to human health and to the health of the planet. The two are inseparable. There are so many resources available with membership, including regular live Q&A on specific topics with special guests, including many with our amazing Unstress Health Advisory Panel that we’ve done hundreds of podcasts over listening to with some amazing experts on a wide range of topics. Many are world leaders, but with membership we have our Unstress web podcast series where we take the best of several. Guests and carefully curated specific topics for episodes which are jam packed full of valuable insights. So join the Unstress health community. If you’re watching this on our YouTube channel. Click on the link below or just visit Unstress health.com to see what’s on offer and join now. I look forward to connecting with you. Yeah. And you’re basically describing life, aren’t you, to the fact that things are connected and and there’s a lot of uncertainty. But we and I think this is what attracts me to so many ancient philosophies and approaches to health in particular. But life in general is this belief in the interconnectedness of everything. And and that doesn’t lend itself to the sort of Descartes type reductionist model breaking things down into their smallest parts and making everything statistically significant.
Dr Andrew Ahn [00:33:23] Yeah, absolutely.
Dr Ron Ehrlich [00:33:24] And I mean, I just described I just described the difference between Western medicine and integrative approach.
Dr Andrew Ahn [00:33:31] Absolutely. Yeah. You hit it right. You hit it right on the nail. And I think that that is the challenge. And in fact, this reminds me, like when I first started to do a rotation internal medicine at NYU, in fact, it was at Bellevue Hospital, which is a public hospital in Manhattan. I remember rounding with one of the attendings and there was a patient with congestive heart failure. And this this person had, you know, significant peripheral oedema, a lot of fluid in his lungs. And this this attendee asked me, so how would you treat this congestive heart failure patient? And I in my mind, I was trying to think of all the complex ways in which this individual started to get congestive heart failure. You know, how how’s the kidney? You know, retain salt, how’s the heart interact? And then the answer he gave me blew me away. And it was like, you just give, you know, diuretics, you give Lasix. And I said, wait, that that’s it. Mean, is that that’s your answer? And basically, to me, it felt like it was answer It was just treating the symptoms and it wasn’t treating sort of the underlying dynamics. And and that’s sort of prompted me to really look into something deeper than just treating the symptoms. And I think the thing is that reductionism is great. It does a lot of things, and this is how we truly understand it, you know, because we want to break our body into smaller parts. And this is how we understand the genomics, the genetic, you know, we understand all the parts of it. It’s just that we haven’t really understood yet. I mean, we’re trying to get there, but how all these parts are sort of speaking to each other. And I think that was the part that was frustrating to me during my early training years.
Dr Ron Ehrlich [00:35:20] But it does go a long way to explain why there’s a 1.5 or $1.6 trillion pharmaceutical industry, doesn’t it? Yeah. And we enjoyed such poor health. I think those two things need to be juxtaposed on each other. But coming back to your interest and and I know that your interest in wearables and digital health and what it can, what it can really achieve, what are some of the things that you’ve found? You know, what is lab front doing? Tell us a little bit about lab front, because that’s very much on their on the front of of wearables, isn’t it? What do we measure and why is it. Yeah.
Dr Andrew Ahn [00:35:58] Right. So I’ll give you a little bit of a back story of how I got here, and then maybe you could understand why I’m very interested in this area. So I had been doing research in acupuncture and really trying to understand the electrical properties of these points and meridians and also just various electrical mechanisms, including college and electricity and other things like streaming potentials in fasting blood flow. So that was another thing. I mean, I was trying to do that, but I think it was too fringe that I couldn’t get any funding. And around that time, acupuncture there were a number of big randomised clinical trials that showed that acupuncture, the acupuncture showed no difference compared to sham acupuncture, you know, for a number of conditions. I forgot what they were, I think it was back pain, etc.. Interestingly, those two did better than standard care. But I think that the big message was that there was really no difference between firm and sham acupuncture. And so as a result, there was less of an interest in acupuncture. And I saw that funding in this area was probably not going to, you know, portend well for my research career. And I took a lot of the understanding that I learned from Chaos theory, nonlinear dynamics, and then sort of moved into the centre for Dynamical Biomarkers, which was a lab at Beth Israel Deaconess Medical Centre. It’s headed by this remarkably brilliant statistical physicist by the name of S.K. Peng, and he had a lot of these nonlinear measures to understand the signals that you can extract. From Time series, like for instance, heart rate that you can get not just, you know because our assumption with heart rate in the past was that, you know, it’s healthy to have a very stable heart rate of like 60 beats per minute. But actually, there’s a lot of fluctuations of variability within there that’s really useful. And one sort of overriding sort of theme of the analysis that Kipping and our lab did was to understand this notion that good health is actually a is a balance between order and disorder. For instance, if you take a look at congestive heart failure patients and if you take a look at their heart rate, their heart rate tends to sort of stay at a very stable level. So their heart rate variability was low. And the reason was the heart was at this event in many congestive heart failure patients. It’s at the state where it’s not able to register some of the regulatory mechanisms to control the heart rate. So the heart rate is quite, you know, or really ordered to stay. On the other side, you have something called atrial fibrillation where it is extremely disordered. And in fact, if you take a look at the heart rate variability, it is very high in all the literature that’s out there in terms of high heart rate variability being healthy, it does not apply to it’s in healthy, normal sinus rhythm individuals, people who have normal rhythms with age of tribulation. On the other hand, it is highly variable because you have multiple sort of areas that are stimulating the heart rate, the heart to beat. And so that is unhealthy too. So too much disorder and too much order are both and are both unhealthy. So you need that sort of the sweet middle go to Locke’s range where there is a variability which is stable enough to maintain order, but it is disordered enough so that it’s adaptive, so that you sort of if there’s any type of stressor, it’s able to adapt to it. And there is a mathematical way that we could sort of extract that. There’s something called multiscale entropy, the trend of fluctuation analysis. It gets a little complex, but you can extract that from time series such as heart rate. And so that, you know, I think after during the Kobe time we realised that there were opportunities for us as as things started to go more remote and also as digital devices became more mature, that there was this opportunity to really take this understanding to where world situations and take it away from the hospital. Because, you know, our system is designed around sick individuals who come to the hospital and then we give them treatment. But that treatment has been after all these things that happened beforehand. And we felt very strongly that we had to get to the individuals when they’re at home, understand sort of the dynamics so that we could, you know, capture disorder or any sort of disease before it manifests, you know, significantly. And so that sort of got into us creating lab front. And what we do at live front is that where our primary clients are actually academic researchers, because at that time during Covid, a lot of the academic research shut down because patients or study participants couldn’t come into the hospital, and as a result, they needed a way to collect data outside of the hospital. And so we felt, this is an opportunity to bring wearables to help researchers out. And we also during that time partner with companies like Garmin who are willing to make the raw data from their watches available to researchers. I mean, this is not true for like Fitbit or Apple or even Woohp. They don’t make the raw data available to researchers. And so we were very interested in working with these these partner companies who are willing to make that data available to researchers. And we’re helping researchers to work with this data and really go towards the home real world settings, then focus much more on prevention, focus on exercise, mental health and stress, sleep, nutrition, social interactions, all the things that I think we ignore in the medical system simply because our system’s not designed to extract that information.
Dr Ron Ehrlich [00:42:41] Wow. Well, you know, I mean, you you mentioned because we did a. Program. I’ve mentioned this to you before we came on, we did a program a few months ago with Norwegian doctor Dr Torkel Ferro, who has written a book called The Pulse Cure and talks very much about the the importance of HIV as a heart rate variability, as a measure of our body’s ability to adapt to stress. And as you. Interesting to put for you to put it in the context of. Too much order, meaning you might have 60 beats per minute and that means one beat every second. That would be a very low heart rate variability, not good. And the opposite of that would be atrial fibrillation, which is going crazy. But you know, if our heart rate can vary by a few milliseconds on either side of a second. Sometimes more, sometimes a little less, it tells us how our body’s responding. But I’m interested. And he mentioned Garmin being his preference because they’ve been using technology for over 20 years called First point. And interesting to hear you now say they are a company unlike others. And I’m not doing a plug here for Garmin, although I sound like I am, you know, who are willing to share their data with you. You know, this is really an important. Important thing for for public health, really, isn’t it?
Dr Andrew Ahn [00:44:09] Yes, absolutely. And I think, you know, I think there was a trend for a period of time and I think there may still be where, you know, the big tech companies that are out there, they make money out of the data. And, you know, and there’s this opportunity to sort of make it so that they can repackage it, even sell it to third parties. They would develop their own algorithms then subsequently make. Off money off that algorithm. But there is that trend towards sort of big companies and corporations having more power, whereas the patients are steadily losing it and the patients are the ones who are generating the data in the first place. And I think, you know, to us that was a travesty. I think that’s something that we felt had to be reversed. But Garmin is a Mid West American company. They’re out of Kansas City, actually a suburb of Kansas City. And they are highly principled. They don’t use the data and repackage and sell it. They’re very strict within their own company that people don’t use that data, you know, for their own sort of personal gain or whatever. And it’s just been an amazing partnership and it’s really encouraging to hear like these big companies have an ethos that tries to sort of, you know, empower patients and citizens to really do better with their health. And so there are other companies like that as well that we’re looking to partner with this. As well.
Dr Ron Ehrlich [00:45:40] Because you were involved in a prize, Qualcomm, XPrize tricorder competition that fascinated me. Tell me about that.
Dr Andrew Ahn [00:45:51] Yeah, that’s yeah. So the prize is a mouthful. I don’t know if you’re a Star Trek fan.
Dr Ron Ehrlich [00:45:57] But I was, I guess not a recent, but, you know, Star Trek goes back a long way and probably before, you know. And anyway, I was let’s say that gone.
Dr Andrew Ahn [00:46:07] But many, many of your listeners may not be, you know to to air of Star Trek. Maybe they’re more into the Marvel world. But in Star Trek, the doctor who the captain, James Kirk referred to as Bones would carry a tricorder, a tricorder which had this ability, you know, to scan an individual who encountered some malevolent alien and figure out what the problem was. Now, X Prize is a foundation out of California that puts up these moonshot challenges to challenge, you know, private individuals, corporations, whoever that wanted to address a moonshot challenge. And at that time, it was to create a device that emulated tricorder device that, you know, was depicted in the Star Trek series. And the goal was to create a device that weighed less than £5 that was able to diagnose up to 15 medical conditions. And these conditions were all over the place just to make sure that wasn’t just a one trick pony. It would be otitis media, COPD, atrial fibrillation, sleep apnoea, diabetes, melanoma, etc. And so out of 350 teams, our team out of that centre for dynamical biomarkers, we were the runner up winners and it was just a that actually was our foray into wearables and that’s how we actually started the lab front. So the X Prize was an outstanding opportunity to learn a lot about how wearables could. Be used for diagnosis, but also monitoring and possibly therapeutically as well.
Dr Ron Ehrlich [00:47:51] Wow, that’s so exciting to hear you say. What? Being able to assess, dare I say, diagnose 15, 15 conditions?
Dr Andrew Ahn [00:48:02] Yes. Well, they they actually had to cut it down because there was hepatitis A was one of them. And I think they couldn’t have enough people to sort of test out the validate it. But anyways, it was down to 13 or something like that. But yes, it’s.
Dr Ron Ehrlich [00:48:15] Still impressive, still in person. I love this expression that I know you’ve used and that is the citizen scientist. It’s a theme we’ve explored recently also on another podcast with a foundation in the UK, which I’m proud to be ambassador to now called Food for the Brain. And it’s talking about citizen scientists, because I think that really is where the potential and the future for improving public health lies in empowering individuals. And this is exactly what you are doing with your with your lab front initiative.
Dr Andrew Ahn [00:48:53] Yeah, I would love to learn more about. We will we.
Dr Ron Ehrlich [00:48:57] Will talk about it. We will talk about it. But this these new ways of understanding health give people tell us tell us what that can deliver for an individual.
Dr Andrew Ahn [00:49:09] Yeah, I think, first of all, our conventional medical sciences are based off of the type of data that we are. We have access at hand to to analyse it. And so a lot of the conventional medical data are based off of visits that patients come maybe every year to. So a lot of the epidemiological studies like Framingham is based off very intermittent, sporadic data collection. And as a result of that, you know, since you don’t have that much data on one individual, you kind of need to do an average over a whole population. And so this is how the randomised control trial makes sense because you basically want to control for all other confounders and you’re just adjusting for one factor and that’s being the intervention. And so you’re basically comparing an average of one group compared to the average of another group. What’s happening though is that the type of data and the granularity of the data is just increasingly becoming more complex and sophisticated. And so what’s happening now is that because of these wearable devices, we’re able to assess heart rate movement, sleep stress, etc., for an individual over many days. And you’re able to potentially also understand the circumstances under which those physiological changes that you’re capturing from the devices are occurring. And so the data now is now making it possible for science to now evaluate an individual specifically and understand the patterns that sort of contribute that person’s health. And so that includes, you know, how does, for instance, physical activity change your sleep or how does sleep change your physical activity? How does eating this type of food affect your sugar levels? And because each individual is very different, phenotypically and genetically, they’re you know, they’re going to have different patterns. And the thing is, you know, what applies to one person does not apply to another person. But now with the about the availability of this data and also increasingly the availability of machine learning, availability of complex and analytical approaches, we’re able to get to the physiology of a person and truly deliver personalised care. And I think that’s where citizen science is potentially growing. And the key part is that we’re not relying on medications. We’re not relying on these expensive treatments. We’re relying on individuals who are proactive in their own health. Ideally, they understand their patterns, understand where they could sort of make a difference. And I think that’s where I think we’re excited about the possibility of empowering patients so that they’re so knowledgeable about what’s happening that they could really make a difference to their health and not get to the point where they’re so sick that they get to the hospital and get, you know, get treated for these expensive treatments that only address diseases, you know, when it’s way late in that stages.
Dr Ron Ehrlich [00:52:37] Well, that is such a vision of the future. That is so inspiring and so exciting. We’ve talked about I mean, the word. Personalised medicine have been thrown around, for at least the last 15 or 20 years. But the reality of being able to take all of this data and use A.I. machine learning to give us so much information and when I think that the average I don’t know whether this is the case in America, but the average GP consultation in Australia is somewhere between 9 and 15 minutes. And, you know, there’s not a lot of time to get a good history, let alone analyse any data to significantly. I mean this is quite liberating for the doctor to be able to access this information and then spend that 9 or 15 minutes showing great empathy and knowledge about how to use it. It’s quite it’s very exciting, isn’t it?
Dr Andrew Ahn [00:53:38] Yeah. definitely. I think the problem in the United States, and I’m sure this is true for many other countries as well, is that the general practitioners, the primary care physicians here are overburdened by paperwork. They have a large panel, they’re incentivised by the insurance companies to spend shorter times, like 15 minutes, as you say, per patient. And the system, unfortunately, doesn’t give them the opportunity to appreciate the complexity that you’re acquiring from this data. So the sad thing is a lot of the primary care physicians, when they see that they could potentially get access to sort of the data of their patients, you know, the sleep patterns, etc., a lot of them feel overwhelmed. They say that I don’t have the time to deal with this. I you know, I’m already to this level in terms of the amount of work. And the other thing that surprised me was they don’t also want to be legally responsible if something were to happen. And since they have access to this data and if something were something traumatic happened to this patient, they don’t want to be legally responsible, you know, for, you know, that individual having a heart attack or or a stroke or something like that. And so the the the system, unfortunately, is not designed to really deliver the personalised approach that we all need. And so this is where I really think that the citizens need to to play a more proactive role. And importantly, part of that is that the patients should own their own data, that the patients should also contribute their data to the research they feel needs to get done, etc.. So I think this is all about patient empowerment.
Dr Ron Ehrlich [00:55:29] Yeah, I look, that’s actually music to my ears and it’s something that I’ve said very often and that is the problem with our health care system, is that good health may make sense, but it doesn’t make dollars. And ultimately, unfortunately, in health care, that is the driver. And but but I can only see if I was a doctor, this would be liberating. This would be empowering. This would be so exciting.
Dr Andrew Ahn [00:55:57] Yeah. I think as a doctor who doesn’t have to address the sort of the the needs of the the insurance companies, I think particularly there are a number of doctors who are going to the concierge service. I don’t know if that’s.
Dr Ron Ehrlich [00:56:13] I’ve heard of.
Dr Andrew Ahn [00:56:14] That in Australia.
Dr Ron Ehrlich [00:56:15] I’ve heard of that. Tell us just explain the concierge very quickly. Well, yes.
Dr Andrew Ahn [00:56:21] So a doctor in the concierge medicine would have a panel of doctors, let’s say a few hundred of a panel of of patients, I should say about a few hundred patients. But these patients would pay upfront, let’s say 5000, 6000, sometimes $10,000 a year. And the the the doctors then are responsible for the care of these patients. But the patients have this opportunity to see the doctor oftentimes whenever they want, maybe send a text, ask questions. And the doctors now, since they are not in there, since their revenue is coming from the patients directly and they’re getting a set salary by this panel, they’re allowed to spend an hour or even longer with patients. Sometimes they make a house visit, Sometimes, you know, they’ll look up and, you know, find out, you know, if a patient’s interested in acupuncture or massage therapy, they’ll figure out ways to address that patient’s problem because now they’re liberated from the insurance system that forces them to see the patients every five, every ten, 15 minutes. And so that’s that’s a pattern, I think, in the United States. I think that may increase in other countries as well. But that also is liberating. Physicians from the the mill that that is the the medical system here.
Dr Ron Ehrlich [00:57:52] And that the mill just to juxtapose another thing over the mill of the medical system is we’ve done a program with a former oncologist who’s now a health coach to the medical profession. And she shared a statistic which said 44% of doctors and 60% of nurses in Australia suffer from burnout. Characterised by an acronym D, disengaged, ineffective and exhausted, which is quite a a sobering thing to know of the people delivering our health care system.
Dr Andrew Ahn [00:58:24] Yeah, that’s absolutely true in the United States too.
Dr Ron Ehrlich [00:58:26] Yeah. Yeah. Now, Andrew, this has been fantastic. As I said, I’m so looking forward to talking to you. I just want to finish with this one question. Taking your taking a step back from your role as the researchers doctor in primary care in the tech world as well, because we are all individuals on a health journey in this modern world. What do you think the biggest challenge for us as individuals on that journey is?
Dr Andrew Ahn [00:58:56] Well, that’s a great question. Well, I mean, I think the the biggest challenge is just asking what is possible. I think the the problem I think in much of conventional medicine is that our system, I think when we’re operating in a system, we only think within the framework of that system. And I think many of these, you know, physicians, health care providers, nurses, etc., they’re doing they are doing what they think they know they feel is right. And it’s basically what they’ve been taught. The unfortunate thing is that a lot of this is incentivised by a system that I don’t mean to sound like a conspiracy theorist, but it is based off of, you know, people being sick. So you get benefit by doing more operations procedures. The medical system benefits from that. And I think that challenge of individuals is and it’s increasingly becoming evidence so is that people are becoming more aware of the fact that, ah, there are answers outside of the conventional approach. And I think podcasts such as yours, people who are, you know, enthusiasts, you know, in terms of understanding the nutrition, human performance, a lot of the things that’s out there that’s a little bit outside of the arena of conventional medicine is really advancing the sciences here. And I think the challenge of all individuals is basically just to think a little bit with an open mind and understand that there are answers that are out there that doesn’t require necessarily, you know, taking a medication. So that’s I think that’s hopefully answers your question.
Dr Ron Ehrlich [01:00:47] It does. And thank you. That’s a great note for us to finish on. And thank you not only for all of the work you are doing to empower those individuals, those citizens scientists to better health. But thank you so much for joining me today and sharing your knowledge and wisdom with us.
Dr Andrew Ahn [01:01:03] Thanks for having me. Doctor. Thank you.
Dr Ron Ehrlich [01:01:06] Well, what an interesting combination. As an internal medicine physician, so he really is there at the coalface, working in hospitals, dealing with patients face to face. But on top of that, he’s exploring how the human body works at the most fundamental level of electronic pulse, you know, of of pulses and MPH and milliamps and and the way that we are engaging, many people are engaging with it as a wearable device. And I do feel that wearable device is an interesting one. On the one hand, they do provide us with some great information about how everyday life fixes the quality of our sleep. Heart rate variability is a good example of that. Heart rate variability gives you an indication of how well your body is adapting to stress. So I think it’s a really interesting thing to learn about. The one thing I find a little bit worrying about the devices is the contact of wi fi radiation on the human body permanently. And I know I have had all of the devices. I’ve had a work band, I’ve had an aura ring, I’ve had a Fitbit, I’ve had a gunman. I was really inspired by that episode I did with Dr. Torvill Farrow and his book The Pulse Pure. So I explored the Garmin, and I thought that was really interesting because it gave us gave you HIV in real time, heart rate variability in real time. And it was really interesting to see how a glass of wine could affect your autonomic nervous system and how two glasses of wine could. Things like that are great, but I think you can also get a bit obsessed by it. Apart from the EMF radiation, you can also become a bit obsessed by it, and that’s not a good thing either. But there are so many wonderful things in this episode and so many interesting things that he brought up. Look, I would also remind you to join our Unstress health community. I hope this finds you well. Until next time. This is Dr Ron Erlich. Be well. Feeling stressed? Overwhelmed. It’s time to Unstress your life. Join the Unstress health community and transform stress into strength. Build mental fitness from self-sabotage to self-mastery. And together, let’s not just survive, but thrive. Expert led courses, curated podcasts, like minded community and support, and much more. Visit Unstress health.com today.
This podcast provides general information and discussion about medicine, health and related subjects. This content is not intended and should not be construed as medical advice or is a Substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences and conclusions.
