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David Rabin MD, PhD is the chief innovation officer, co-founder and co-inventor at Apollo Neuroscience Inc. His work focuses on developing technology to change the way that we approach patient care more effectively.

Transcript

Dr. Sohaib Imitaz: Hey, guys. Welcome to another episode of the Body Clock podcast. Today, I’m excited to have Dr. David Rabin on our show. He is a psychiatrist as well as a neuroscientist, and he is the co-founder of Apollo Neuroscience. Quite an exciting and emerging technology dealing with stress and resilience and helping you perform at your optimum state. So I’m going to let David explain a bit more about his background and how he got involved with what he’s doing. And I look forward to listening about what he has to say. Hey, David.

Dr. David Rabin: Hey, how are you? Thank you so much for having me.

Dr. Sohaib Imitaz: I’m good. I’m glad you could come on.

Dr. David Rabin: Yeah, me too. I think we have a lot of synergy in this space. Yeah. As you said a second ago, my background is in psychiatry and neuroscience. I’ve been focusing my research for just over 10 years now on chronic stress on the body and the effects. I originally started out looking at the effects on the cellular and molecular parts of the nervous system in dementia and aging blindness disorders and then realized that I was much more interested in working with people on the whole.

And so I transitioned into psychiatry where I focused mostly with people who have tumors and trauma disorders, like PTSD, and addiction disorders, and any other disorder that’s worsened by chronic stress, which often includes things like chronic pain and insomnia, depression, anxiety, and these kinds of things.

Dr. Sohaib Imitaz: So it seems like you spend quite a lot of time really getting the depth of all these kinds of debilitating chronic processes that people suffer from. So you’re quite an expert in that. So whilst you were doing that, did you always have an interest in technology as well?

Dr. David Rabin: Yeah, I think I always saw an opportunity for technology to change the way that we approach patient care more effectively. I think, you know, as we were talking about earlier, as physicians, we focus a lot on the biological processes of the body that have been studied for the last hundred years but we don’t spend a lot of time looking at the ways that we can more effectively understand those processes.

We kind of focus on this is what we know and this is how it is. But ultimately, what I think wearable technology has brought to the table is an opportunity to. And I realize that I think, you know when Fitbit they came out and I don’t know you’re familiar with BodyMedia, which is one of the first wearable companies. I think it was the first for tracking where metrics actually came out of Pittsburgh, where we’re located.

And we have a lot of heritage of wearable technology here to identify not just activity and health, but also emotional states. And so I always had an interest in that and just using that technology to sort to understand not only what’s going on from our patients’ mouths when we see them in the office, but more importantly, I think what’s going on in their day to day lives at home. And there’s a huge barrier in health care that we’ve been witnessing.

I think not just in the US, but around the world where, you know, our patients come in and they’ll tell us. And this is really common in psychiatry. You ask your patients how they’re doing and they tell you about the day and they’ll tell you about the week, you know. They came to visit. But they’re not particularly great at remembering what happened the other 6 or 8 weeks or 12 weeks before, you know, between their last appointments.

And so wearable technology really provides us and it’s not there yet, but it can have the opportunity to provide us with an incredible amount of information about what our patients are doing on a daily basis at home so we can more effectively manage their care.

Dr. Sohaib Imitaz: So I think that would really help transform health and for the normal individual. So you talk about stress. So the best way of measuring stress, would you say that’s heart rate variability?

Dr. David Rabin: That’s a great question. You know, I think there’s a lot of different ways to measure stress. And I think we’re still learning about what the body looks like under stress. I think one of the most important things that we learned in medical school- to fall back to that, we didn’t study in enough detail but is the autonomic nervous system and sort of understanding the balance between the sympathetic fight or flight or freeze response system with the parasympathetic rest and digest and create and reproduce and sleep system.

And those two systems are sort of a dynamic interplay in the body, in the brain. And when we understand what those systems do in response to stress and the response to safety, it starts to shed a lot of insight into what we can predict people’s bodies look like under stress. Hari variability is a really interesting measure that actually was discovered in the 1950s and 60s with Hari variability biofeedback.

Hari variability in and of itself is really just the rate of change of your heartbeat over time. So it’s really looking at the amount that your heart rate is shifting when you’re exposed to stress and how quickly it shifts when you’re exposed to stress. If it should go up quickly, your blood pressure should go quickly or respiration to go up quickly. And the purpose of that is to get you out of that situation.

And in turn, when you’re in those sympathetic responses, your heart rate variability is low because your heart rate is very high and doesn’t really matter that you’re able to adapt and switch quickly, you just need to get out. And so under stress, Hari variability is typically low and that’s an indication as well that your parasympathetic nervous system, the rest in digesting and create system, the reproduction system, and the system is essential for doing everything from managing your gut microflora to your emotional health is totally suppressed.

So when you’re under these high stress states, because your body is not supposed to be worried about any of the things like reproduction or creativity when you’re running from a bear. And so ultimately, what really chronic stress is it’s these little situation times that result in sympathetic activity that is increased and parasympathetic activity that decreased all the time.

And what happens is all the things that the parasympathetic system is important for governing stop working well. So your ability to regulate your sleep, your digestion, your immunity, your recovery, your ability to transition between stress and not stress dates, wakefulness- we say all those things start to dysfunction under chronic stress situations when the sympathetic nervous system is overactive.

And so we can see that because people who have chronic stress or conditions related to chronic stress like PTSD and depression anxiety tend to all have low heart rate variability, which is a sign that their sympathetic nervous system up all the time. And so what we found through seeing patients and through, you know, doing thorough literature review is that ultimately it is a pretty strong consensus activity like meditation, mindfulness, yoga, deep breathing, massage, really excellent psychotherapy, and things of that nature boost heart rate variability and reduce symptoms at the moment during the session in these conditions or in patient- people of chronic stress.

And so there’s been these really strong links between activities that boost Hari variability and help them sort of reset the nervous system and help reduce symptoms and improve attention and emotion regulation and mood regulation and circadian rhythm regulations. I think it’s a very important topic that you guys talk about a lot. And so that is sort of the basis for all of the work that we do is looking at how do we help people who are constantly in a threatened state achieve a more natural safe state more effectively so that they can more effectively engage in their own healing process.

Dr. Sohaib Imitaz: So would you say that it’s shown to have a massive impact scheduling such activities to relax and, you know, meditate in your day to day life when you are in a threatened state for maybe, you know, deadlines working too hard or even, you know, if you’re going through some type of traumatic situation or financial situation or maybe something like a breakup, do you feel an activity such as meditating or yoga can help counteract that and improve your heart rate variability?

Dr. David Rabin: Yeah, that’s another great question. I think you’re absolutely right about that. Those activities can help improve your heart rate variability and improve balance between the sympathetic and parasympathetic sides of the nervous system, which over the long term if you practice meditation or mindfulness