 Can you give the listeners a brief introduction of the Ring and how it works? So, just a brief history of Aura. Aura was founded in Finland in 2013. We are on our generation three product now. Generation one Ring was launched in 2015. Gen two was launched in 2017. And Gen three, our latest product was launched in late 2021. Aura Ring is, as Dr. Gunry just showed, and I have a couple on my fingers, is essentially a wearable ring. It weighs about four grams and has a suite of sensors packed into it. And these sensors are integrated into the Aura Ring to measure different aspects of your physiology. So there are three LEDs with three different wavelengths in the ring, red, green, and infrared. These are in the ring for different types of measurements of the blood essentially that is flowing through your arteries. We have an accelerometer and a gyroscope which measure your movement in three dimensions. And we also have seven temperature sensors that make very high resolution measurements of your of your body temperature 24-7. And the sort of the foundational or the most sort of the first things you would experience if you had an Aura Ring would be these three scores. They're readiness, sleep, and activity. And readiness is essentially a score that tells you how ready are you for the day? Are you well rested? Are you ready for pushing yourself? Or should you take it easy today? It's essentially a guide for you that tells you how you might want to go through your day. And also helps you understand what are the factors that contributed to how you are feeling today? Sleep being one of them. Sleep is the second score, sleep score. It tells you basically how well you slept last night. And that includes a bunch of different things. How much time you spend sleeping, the total time that you gave yourself the opportunity to sleep, how efficient your sleep was, where was your sleep restful? How much REM sleep did you get? How much deep sleep did you take your long time to fall asleep? And was the timing of your sleep aligned with your circadian rhythm? So these are all these factors that contribute to the sleep score. And it essentially tells you how you're doing with respect to sleep and what are the things you can perhaps do to improve your sleep next night. And then finally we have the activity score, which includes about six contributors. And it basically tells you how whether you have been staying active, are you moving regularly? Are you meeting your daily activity goals? How much help frequently? Are you training? And what is the volume of your training? And also, are you giving yourself enough recovery time to essentially let your body recover and get ready for the activity again the next day? So let me ask you one thing. So my wife loves to tease me. She'll say when we get out of bed in the morning, how did you sleep? And I'll go just a minute, I'll let you know. And I pull up the aura results. And she says, that's ridiculous. I want to know how you slept. And I said, well, this ring knows a whole lot more about how I slept than my perception of how I slept. What say you? Am I right? Are you right? Or is my wife right? This is all just fanciful thinking. Yeah, no, it is. It is interesting. I think there are a lot of studies that have tried to compare how your subjective feeling of how you well you slept or how you think you slept aligns with the objective measurements. And the interesting thing is that these two things don't correlate well. I mean, you would expect them to, but they don't. And I think that is one of the reasons why having this objective data. In addition to, I don't think that how you feel is not important. It actually is very important. And not just for sleep, but for any aspect of your health as you were trained doctors. So you'd probably be an advocate for that. But when it comes to sleep, it's the same thing. I think it's important to know or understand how you're feeling. But it's also important to understand the objective aspects, the data behind what are the factors that may be driving, how well you slept, or how well you did not sleep. And I essentially identify some of the gaps between your perception of sleep and what your body's experiencing during the night. The other thing is that sometimes you need that this type of sleep depth to build up before you actually start feeling some of the effects. When with data, you can actually have a little bit of an early warning to warn you that you might be heading down the path that may be harmful for your health. And I think one of the interesting things that sleep scientists are discovering is that sleep debt is not something that you can just pay off. If you get like two, three hours of sleep for a week, just by sleeping more the next week, it's not like you can just catch up. There is a deficit that can be sustained over very long periods and can almost have some kind of permanent impact on your health, especially when you have severe sleep deprivation. So data is, I think, not everything, but I think it's an important aspect of understanding your sleep. How, we are talking off camera, how has this sleep tracking technology evolved over time? Because this is now the Gen 3, and you mentioned that Gen 4 is on the way. What's changed? What have you learned over the past number of years? Yeah, so when ORA started in 2013, the focus was on sleep. So we've always had a very strong focus on measuring sleep and getting deeper insights for our users on how they're sleeping and what they can do to improve their sleep. And so from a sleep measurement point of view, we have essentially been continuously at work improving how we measure sleep also in terms from a sensing point of view. How can we go get more accurate measurements? And so if you look at our evolution from Gen 1 to Gen 2 to Gen 3, we have essentially added more sensors into the ring that enable us to measure more aspects of your physiology. We've also pushed towards increasing the resolution. One of the things that we've done in the most recent generation of the ORA ring, which is an enabler for us to go to this more advanced algorithm that we are working on implementing right now into the ring, is simply increasing the memory. So we are doing more processing on the ring. So with more sensors, you're capturing more data. And in order for us to get the most out of that data, we also need more processing power and more storage. And so the same thing that is happening in sort of the machine learning, deep learning world with the explosion of data and advancement of these techniques for processing this data, we are able to do some really amazing feats, right? And the same is true for what we are doing with the ORA ring. So our next generation algorithm, which you just mentioned, is essentially taking advantage of all these added sensing capabilities in the ring, along with really advanced computational capabilities that we are unlocking with the new hardware and coupling that with advanced machine learning techniques to, I think, deliver the most accurate sleep tracking yet. If you think about the history of measuring sleep, that is sort of the first, the polysomnography, which is the clinical standard for measuring sleep, that was invented in 1973 or 74. So it's still relatively recent in terms of the ability to measure sleep. And again, polysomnography is something that has typically been performed in a sleep laptop of environment where you go in, you spend a night wired up, you have hundreds of electrodes and devices set up to you and then you're asked to sleep in a strange new environment. And that's been the standard in science of sleep. That is changing with more home sleep testing, but it's still very cumbersome from a set-up point of view. And so the science of sleep is also evolving and ORA has been leading the charge in terms of evolving the science when it comes to wearables. And I think we will continue to do that for a long time, I think. Okay, let's get back to sleep in general. Hard charging Americans say, well, I'll sleep when I'm dead. That's the least thing I have to worry about. But in fact, we know that lack of sleep kills you. I mean, it definitely shortens your lifespan. We know that blue zone people in general get eight to 10 hours of sleep a night and they actually frequently take naps. Where is the science now? How much can somebody get by on four to five hours of sleep? Or are they going to pay for it eventually? Or is there a range where each of us needs and how do you find that out? Big question. Yeah, most people need seven to nine hours of sleep a night. And there is variability. There are people who have this genetic mutation that it's a very, very small percentage of people who may be able to get by with less than that. But most people by far, majority of the people need about 79 hours of sleep. And you're absolutely right. I think we have a massive sort of epidemic of lack of sleep that is going on. And I mean, some of the stats you mentioned were quite stark. One of the stats that I know is that you have one in five car crashes are caused by drowsy sort of driving. And that basically just in the US results in about 7,000 deaths a year. It is a matter of life and death literally right when it comes to lack of sleep. And then there are all these other potential long-term effects like there's been linked with these proteins building up in your brain with beta ammovoids and towels and that are linked with potentially causing Alzheimer's in the long-term. And then there are also risks for hypertension, diabetes, you know, it affects your immune system. So there is a whole lot of science behind sort of sleep as probably one of the best things you can do for yourself to improve your health. And you can multiple different ways, both sort of short-term improvements as well as longer-term improvements to your health. And around this aspect of getting enough sleep helps you improve your health. I don't think there is much debate around that, at least, you know, from a scientific point of view. I think sleep is quite critical for functioning. And it's sort of like an essential biological need for humans and animals to work, right? Yeah, you know, it's interesting when I was a surgery resident, surgeons, I remember when I went to the University of Michigan for my training, and I came from Georgia Medical School where we actually, as medical students, worked through the night. And when I went to Michigan, the medical students on my service said, well, you know, it's five o'clock, we're going home now. And I go, what do you mean you're going home? The most important stuff is going to happen, you know, tonight at two o'clock in the morning. And they said, no, we're not allowed to be here at night. We have to get our sleep. And I'm going, are you crazy? You know, they were, and this was, you know, a long time ago. And they were actually well way ahead of the curve. And we now residency programs have controls on how long you can, you know, be on call, how long you can be awake. When I was chief resident, I went four days without sleep on the chairman's service. And then I slept for four hours and went at it again. And oh, yeah, and we now know that Wow, you know, that's like me driving a race car without sleep. You know, clearly, everybody had impaired judgment. Now, luckily, I don't think I killed anybody. But, but that was sort of the culture. And we now know that that's, that's crazy. Yeah, absolutely. And I think that is one of our, you know, one of the, the missions, like, you know, what, what aura wants to do is sort of this making health a daily practice. And I think the simple act of, you know, you mentioned that the first thing you do in the morning when, you know, your wife, your wife might ask you, how did you sleep? And you go to your aura. And it's, it's this act of checking in, right, simply trying to be mindful about how did you sleep, right? I think for me, there are lots of benefits of aura and like the data and the insights. But the, the, the biggest one in my mind is, is this change in your mindset about checking in the first thing in your morning and thinking about how did I sleep? And, and, you know, let me understand this. And I'm hoping that, you know, as we as more people use aura rings and in general, I think the awareness of the importance of sleep becomes, you know, more widespread. I'm hoping that all of these, we will see improvements across a lot of these other aspects, right? Like long-term impacts on health, you know, and also the shorter term impacts that you, you know, sleep has on your, on your ability to perform and, and, you know, be well in doing the day. You mentioned something earlier that I think is an important message. I want to, I want to talk about that. Many of us have been taught that, well, during the work week, we have so much to do. We have to get it accomplished. We'll work late into the night and we'll, we'll catch up on the weekends. We'll sleep in. And that, you know, kind of makes sense, but your findings and sleep study findings in general say, no, that's not the case. You, you literally cannot catch up. Is that true? Yeah. I mean, I think catching up, you do people, you do see the pattern, right? When you have, you know, if you look at patterns of people sleeping in during the week and, and weekends and we look, we see that in our, in the data for our users as well. You see this pattern quite clearly shorter, you know, sleep opportunity during the week, and then people try to catch up during the evenings. And there are actually some really interesting cultural differences as well. If you look at, you know, people across different countries, you see different patterns sort of emerging, but you, you know, I think that this, this pattern of people sleeping less, whether it's weekdays or certain days, you know, when there is more work or stress and then trying to catch up is, it happens and we all do that, right? I think we probably all, as you did give your example, I think we've all done that. The science, I think, is building up to say that it's not, it's not that by catching up, you are essentially erasing any of the negative impacts. It probably helps in some ways to just catch up. So I, you know, it's not a bad thing to do to sleep more if you have been sleep deprived. But at the same time, have building a lifestyle around this idea of I'll deprive myself of sleep for a few days and then I'll catch up during the weekend or, you know, it's the science is increasingly telling us that that is not a sustainable approach to sleeping. I think one of the most foundational things you can do for sleeping well and your health is to just build a very consistent sleep schedule. And I think that is also one of the things that, you know, Aura users learned very quickly is, you know, just build a consistent sleep schedule, introduce good sleep hygiene into your, into your evenings, right? How you wind down, I guess things that you, if you start doing these things consistently, you know, you will, you will see better sleep and better health as a result of it. Yeah, you know, part of this I think is we now know that we have multiple 24 hour clocks within us. We have a 24 hour clock in our brain, our gut microbiome operates on a 24 hour clock. And we obviously have clock genes in all of our cells. And I think I tell my patients, essentially, you can't beat the clock. You may try to. But this whole idea that we should be, you know, in time with our circadian rhythms, I'm convinced I just got back from one of the major microbiome meetings in Paris. And we're more and more convinced that a large part or at least significant part of jet lag is actually our microbiome clock doesn't catch up with our sunlight clock. And that it's the lag in our microbiome that's actually causing changes in the biochemical productions that they are affecting our brain with. So there's still a lot to learn about all of this. Yeah, no, I think the science is fascinating. And it's still, you know, there's so much that we need to learn. And as I was mentioning, I think before before we started recording sleep has been thought of as predominantly a brain process, but it is a full body process, right? In reality, I think that's just how we've been measuring it. And as the science evolves, I think we'll learn that sleep is connected to pretty much every aspect of our physiology and all the processes that happen in our bodies. So it is fascinating. And that's one of the reasons why I feel like, you know, Aura's early focus on sleep was quite visionary, right? You know, in 2013, if you think back, most of the variables were focusing on counting steps or, you know, activity tracking and those types of things. Sleep was not necessarily a big part of the conversation. And so the foresight, you know, was quite remarkable in terms of in focusing on sleep and really going deeper into understanding your sleep. Okay, we talked about time of sleep, but probably more important. I think you guys are really leading the way on this is sleep efficiency. What happens from the time you go to bed until the time you get up the next day? What? I mean, come on, I go to bed, I go to sleep, and then I get up. That's pretty simple. But you're saying there's a lot happening that you probably ought to know about during that time period. So what's sleep efficiency? Yeah, sleep is a fascinating process. And I think that I've, in terms of learning, I've probably just scratched the surface of how sleep is from a function point of view and the physiology of sleep and things like that. So there's a lot happens during sleep. Sleep efficiency, you know, to answer a specific question. Sleep efficiency is a very simple metric that just tells you how well did you sleep? So it is essentially describing the amount of essentially percent. You went to bed and you woke up in between that time. How much time did you spend sleeping? So when we are sleeping, we go through these stages. At a high level, there are four stages of sleep. Wake, REM, light and deep. And light and deep can be subdivided into two more stages each. So N1, N2, N3, N4. And I can talk more about that. But at a high level, there are these four stages. And most of our nights, we cycle through these stages. And typically, I think we experience about four to five 90-minute cycles of these stages, cyclical patterns. And essentially, efficiency tells you that how much of this time were you in the wake state and how much of the time was spent in the rest of the stages? So it's a high-level metric, but it's a very powerful metric that tells you how well you are sleeping. When you're giving your body the opportunity to sleep, how well are you able to take advantage of that opportunity? And then from sleep efficiency, you can go deeper into understanding when you are sleeping, how is your sleep architecture? How much time are you spending in your light sleep, REM sleep, deep sleep? Each of these stages has their own significance in terms of the benefits and what they do for your body and mind. And so sleep efficiency is the first place you would want to start, but then you also want to go deeper into how you're sleeping in terms of the stages. So I notice, particularly when I'm sleep deprived, or when I'm up with a patient or something, or time zone travel, I will frequently, the first few nights after these episodes, have a lot more deep sleep. And personally, I like deep sleep. I think, another thing, that that's when we do our brain cleaning, our lymphatic wash. And so to me, it's actually a confirmation that, hey, your brain kind of took a hit in terms of its repair functions and good news, your brains catching up on its cleaning function. Is that just a fanciful thinking or can you see those things? No, you do. So if you, for example, if you push yourself and work out harder a day, you will see potentially increased deep sleep during the night. You will also see reduced latency in terms of falling asleep to fall asleep faster because your body is just craving for that sleep. And then what you would see is, like deep sleep is, most of the deep sleep is preloaded into the night. So like the first half of your night, that's when you get most of your deep sleep. And you will see that if you're very tired because of physical exertion or other types of exertion, then you would quickly get into that deep sleep stage. And it's likely that you would see more deep sleep when you're kind of trying to recover from different stressors. Typically, if you're like going through your normal life, normal daily life, without sort of these types of exertion periods, most adults would see about 15 to 20% of their sleep time they spend in deep sleep. And this decreases with age. So as you age, you will spend less time in your deep sleep. It's not like you always need to have a fix. There is an age component that will also play a factor. And you're absolutely right. Deep sleep is remarkable in that restorative power from things like muscle growth and repair to cleaning up your brain and flushing out these proteins that are building up through the day. It's also important for your metabolic health and function. I think you probably know a lot more about what that than I do. And also immune system, right? I think healthy functioning immune system deep sleep is quite critical to that as well. I and others, including Dale Bredesen, the author of The End of Alzheimer's and David Perlman, think that we really should try to avoid eating for preferably three hours before we go to sleep. And do you guys see an effect of eating close to bedtime, either changes in sleep or do you? Absolutely. I think late meals are one of the key factors that you will notice. If you use an ordering, you have a late meal, you will see it in your data. And you can actually just besides your sleep staging data that tells you more about how you slept, if you go to your physiology data, if you look at your heart rate in the ordering, you can actually see your trend, you will see that your heart rate will stay elevated for a longer time. And it will take longer for your heart rate to go down if you had a late meal. And then basically what is happening is your body is kind of under stress, kind of processing that food and that late meal. And it is having an impact on your ability to get good sleep. So what I think we have found from a scientific point of view that people who eat early and eat a smaller meal at night in the evening, they tend to have better sleep. They tend to sleep better because their body is more ready to go to sleep and take advantage of that opportunity that it's getting. So yeah, absolutely. I think caffeine is another factor keeping your environment cooler. One of the things that happens when you go to sleep is your body temperature lowers, your cold body temperature. And that is essentially preparing your body to get to sleep. And one of the ways you can promote that is by creating a cooler environment for you to sleep in. If your environment is on the hotter side or warmer side, it is going to make it harder for your body to sleep. And that is, again, one of the reasons why we have a temperature sensor in the ring is temperature is a very key metric to track in order to understand sleep and how well you're sleeping. So what you're saying is my wife's mother told her that you always had to sleep with the window open. And so you're saying that that old wives tale probably has some truth to it. Yes, yes. And the same reason why taking a warm shower before going to bed also promotes sleep is because when you take a warm shower, it's sort of from a thermal regulation point of view, your body is going to, you know, your cold body temperature is going to go down, you know, in response to that, you know, the heat, right? So that actually promotes exactly that phenomenon. All right. So you mentioned, okay, so you're measuring temperature on the finger. Let's suppose I sleep with my hand, you know, outside my pillow, and it's up above my head, and it's a cold room. And how do I know that that's my core temperature? What have you done to correct for that? Yeah. So we so we don't first thing we don't measure your core temperature, right? We measure your finger temperature. There are actually some really interesting properties of measuring your sort of temperature on your periphery, right? When you're the palm, most of the sensing that happens in the ordering is on the palm side of your hand, all of our heart rate, like the, the, the very sense of how the blood is flowing through your arteries that happens on the palm side, temperature sensing happens here as well. And when you're, when you know, when your body is kind of this heat exchange, a lot of that happens through, through the, through your palm, right? And so what the phenomena that we measure is actually opposite to what what is happening at the core. So when your core body temperature is dropping, the temperature on your finger is actually going up. So we see the opposite phenomena. The other interesting thing is that while your core body temperature doesn't fluctuate by, you know, significantly, right? Like, I think we see about two to three Fahrenheit such change in your core body, right? Because your body wants to keep your, you know, you don't want to see large fluctuations there. But on the finger, you see a much larger change. So the signal that we are getting on the finger is the amplitude is much larger compared to what you see in the core in terms of just the magnitude of change. And, and what that does is that from while we are not measuring your core body temperature, what we are measuring is a very high quality analog of a signal that is telling us how your core body temperature is changing, which direction, and it is very, very sensitive. And so when in terms of an algorithm and how we use that data, we, one of the things that we do, and we do this for a lot of our metrics, if you, you know, as you probably have noticed is we build a baseline for you, right? So that baseline is based on, you know, long-term days and sometimes even weeks of data. And one of the ways we account for these factors, right? Like one day, let's say you decided to sleep with your hands under the blanket, one day you decide to sleep, you know, there are different things that could happen. But what we do is by using a long-term baseline to adjust for these types of smaller variations. And also during the night, when we, when we're using your temperature, we are actually processing temperature data in a way we are, where we are trying to deal with these types of artifacts or outliers, right? So there are some interesting processing techniques as well as the sort of approach for using long-term baseline data that enables us to really do a good job in terms of like understanding your, how the temperature is fluctuating day to day and even within the night. All right. Since I mentioned my finger, why did you guys choose a finger rather than most of the other tracking devices, whether it's an Apple Watch or a Fitbit or a Whoop, are worn on the wrist? What, I mean, why the finger other than it's an incredibly attractive? Yeah. So I think that I would say there are three, there are three reasons, right? There are three factors behind that choice. One is associated with kind of, it's an incredibly easy form factor to get used to. When you are getting a wearable device, any device, any new piece of technology, right? The first thing, there's a there's a period in which you need to adapt to that technology to get used to it, you know, having and with wearables, one of the big factors is that a lot of people buy, you know, wearables, wrist-worn wearables and, you know, a lot of people don't make it through beyond a few weeks. They end up in your drawer and just think people forget because it's just, they're getting used to is harder. The finger form factor has been remarkable in its capacity to get for people to get used to very, very quickly, right? And so what we see is within the first week, people are just, it becomes sort of like a second nature to use the ring. So that's one. The second one is this aspect of the signal quality, right? So when you're talking about health tracking, and as a doctor, you probably appreciate this quite a bit, is that you want the best information possible in order to make decisions about health, right? The same is for the ordering or any variable, like the better information you have, the better signals you have, the better information you're capturing and the better insights you'll be able to deliver, right? And so the fact that we are making all these measurements on the palm side of your hand helps us deal with things, you know, like skin tone, right? On the palm side of your hand, the skin tone factors are less prominent compared to when you're making measurements on the wrist. You also don't have other things like hair or the other factors that are impeding these measurements. The other thing that helps is that when we are measuring with, on the palm side, we are actually measuring directly from your digital arteries that are flowing in your fingers. Most of the wristworn devices are measuring from capillaries that are located on the back of your hand. So in terms of just the power that you need from a signal point of view to get similar quality data, we are in order to magnitude lower in terms of when we are making measurements on the finger. So more higher accuracy and higher quality of signals. So that's the second reason. And the third reason is, is sort of this idea of, you know, it's more, I guess maybe more philosophical, which is we are having, you know, our philosophy is that we want to be there for you when you need us, right? When we, you know, you can't see notifications, there's, ordering doesn't distract you, doesn't kind of, when you need the data and when you want to, you know, understand what is, what is going on with your, with your health, how you're sleeping, etc. Pouring is there. Otherwise, it's sort of lensing your background. It doesn't sort of like transparent from a technology perspective. So those are, those are the three main reasons, I think, that that has driven our choice of the, the finger form factor and, and the ring form factor. And I think that has driven a lot of the success we've had in terms of tracking. All right. I think one of the exciting areas that you've pioneered and others have caught up a bit is heart rate variability. And I was actually involved years ago in, as a principal investigator in a study looking at who should get automatic implantable defibrillators. And people have heard about defibrillators with Senate candidate Fetterman, who got a defibrillator. But we, we looked at who should get those based on heart rate variability in people with ischemic heart disease. And we found, interestingly enough, that low heart rate variability was, was very predictable, was a good prognosticator for your risk of sudden death from fibrillation. And it was actually one of the things that correlated well with who we felt should get a defibrillator. So I've always been fascinated with heart rate variability. And years ago, I was presenting at a Mind Body Green meeting in Tucson, Arizona. And one of Ora's people, a young man from Finland, and I were talking about heart rate variability. And I was showing him mine. And mine usually runs, oh, 70 to 80. If I'm very vigorous in exercise programs, I'm 130, 150, which I view as a good thing. And he's showing me his data, and he's 270. And I'm going, you know, I hate you. How'd you do that besides the fact that you're 25 years old? And my wife, who is actually a great athlete, big time former marathoner, her heart rate variability is in the 20s. And she says, oh, my gosh, you know, I'm going to die soon. Well, she's not. But explain heart rate variability and why I should be interested and explain to me how I can help my wife, number one. And number two, I have a number of patients who have low heart rate variability. And yet they're actually pretty impressive athletes. I'll just use my explanation. They, my wife has a V8 engine that lumbers along. I mean, she has her resting heart rate is like 42. Yeah. And I said, you're just a big lumbering V8 and your RPMs are so low that that's you. Me, I'm a turbocharged four cylinder. And when I really need it, you know, I can, I can, I can get the gas going, but I need a lot more. I've just got a smaller engine. Is that just making it up for her? Or what do you, what do you think about heart rate variability? Yeah. Heart rate variability is, is fascinating. I think in the science around heart rate variability and how to interpret it and what it means for your health is, is, I think it's really, I mean, a lot of the work has been happening in the last few years, to be honest. I did especially, I think wearables have been a big driver for, for HRB awareness. Like HRB is not something that people think maybe five, 10 years ago, thought about on a regular basis. Now it's, it is becoming, and it is, it is quite a powerful metric, right? As you, as you mentioned, it has, and I was completely like, I was, when you were describing that you were using this for these type of, you know, important medical decisions back, you know, several years ago. 20 years ago. 20 years ago. I mean, I'm not surprised that you were, you know, you were ahead of the curve there. But also, you know, it just, it just, it's just fascinating to see that there was like, if you have people who are experts and under who have that understanding, maybe they were using that, that metric, you know, for some decision making. And I think, I expect that we will be, you know, HRB is going to become something that we will probably start tracking from medical records point of view as well as a metric, you know, over time. I think it's quite powerful. HRB, you know, just for the benefit of the listeners, HRB is, heart rate is essentially measuring your, how frequently, how many beats per minute your heart is beating, right? And it can be higher, it can be lower, you know, and there are lots of factors why that would be. HRB is essentially measuring how regular is your heart rate, right? If your heart rate is 60 beats per minute, it doesn't mean that every second your heart is beating. It's not like a metronome, right? There is going to be variability. So it could be like 0.9 seconds, 1.1, between beats, there could be, there could be variability. And that is what heart rate variability is essentially measuring. How much, you know, how consistently your heart is beating or how much it varies? And surprisingly, like, you know, interestingly, sort of, higher the heart rate variability, the better. That's generally sort of how I think about it. And your heart rate variability is quite fascinating, you know, and like, heart rate variability typically declines with age. And for your age group, you will probably be in like a very high percentile from a heart rate variability point of view. I think generally speaking, higher heart rate variability indicates, you know, better heart health, you know, and better sort of sympathetic, better sort of balance in your autonomic nervous system. But I think there's also in terms of interpreting HRV, I don't think we should get caught up in absolute numbers. I think it's better from my point of view to think about what your heart rate variability is, and it could be, you know, in the 20s or 30s, or it could be like you, you know, 70s or 70, 80, or it could be like this person from Finland, you know, super fit athlete, probably might be like, and that's a very like extreme, right? But at the end of the day, I think what I, how I think about heart rate variability is that tracking heart rate variability is extremely important. It tells you about how well you're recovered, are you busy or body in stress or not. And it is a good metric, like just the changes in your heart rate variability up or down relative to your baseline gives you a good indicator of that. And there are things you can do to improve your heart rate variability. It's, you know, it's, it's, it's not something that if your heart rate variability is 30, it's not like you can double it, right? Like it's, it's, but you can improve it. If you improve your diet, right, there are other factors like exercise and getting, getting fitter. Those are things that could, that could move the needle from a heart rate variability point of view and get, help you get healthier. But again, like you, you're the example of your wife, right, who's an extremely fit athlete. You know, nothing wrong, I think in, in, in our heart rate variability, and I don't know how much room she has if she's already super fit to, to change that. I think what, what I would until more science builds up and helps us understand what are some of the risks, right? If you're a super fit athlete with your resting heart rate in the 40s, which is, which is phenomenal, right? You know, and your heart rate variability is 30. Is that a cause of concern? We don't have the science to say, you know, to build that kind of the, you know, correlation or, or, or, or, or insight. But right now, I think we do understand that paying attention to how your heart rate variability, the balance of your heart rate variability, and that's actually one of the, one of the contributors we use in calculating your readiness score. It's essentially how is your heart rate variability changing compared to your baseline? If it is a little bit better than your wrong term baseline, that's great. If it's a little bit lower, you know, we tell you, right, that you might want to pay attention to what, what, what is going on. It could be illness, it could be stress, it could be that you've been pushing yourself too hard and not giving your body enough time to recover. So there are lots of factors, right? So I think my general advice is that not thinking about HRV in a purely absolute terms, follow the science and, and let the science build up and, and, and, you know, help us understand more about how we want to use this. But I think that, you know, HRV is, is going to be a very important metric that we will, I think everybody will pay close attention to in the future. In a similar vein as a nutritionist, I got to ask, can this, can this data guide us in food selection? What foods are affecting us positively? What foods are affecting us negatively? Or do we not have enough data? Yeah, I think I would say that data is, is building up, right? We talked about, you know, late meals as an example, right? You know, that you could also, you could also get some insights into the quality of your meal, right? If you're having a meal that is, you know, very with a lot of sugar, desserts, you will see a difference between a healthier meal. Even if it's a late meal, you will actually probably see a difference in your, in your physiology that, that will tell you something about the stress that a meal put on your body, right? But I think the science is, science is evolving. One thing that I'm particularly excited about is people who are looking at data from, you know, variables like the ordering and combination with CGMs and food logging and tracking to really understand the association between, you know, nutrition, your, your sleep, your activity levels, your physiology, and, and your ability to, you know, control your blood glucose, right? And I think there's some really fascinating insights that will come from, from that type of work that will help us, I think understand, I'm more at a personal level, right? What are our different dietary choices affecting our health? And yeah, I would, I think I'm quite fascinated about that aspect. And I'm actually curious to hear what, what your thoughts are on that, since you, you know, this is such a big focus area for you. No, I think, you know, we certainly see people with, oh, high sugary food intake, particularly late at night, you're right, their, their heart rates are often through the roof and are very slow to come down. And I think that's actually a good variable. We know that the longer it takes you to digest food, we actually put a huge amount of cardiac output into our digestive tract to, to facilitate digestion and absorption. And I think and others think that that, particularly at night, should be directed to your brain for brain cleaning and brain washing. And I think a lot of the evidence of this late meal or even snacks before bed being detrimental is because we've, our heart output, cardiac output, is directed in the wrong place. And it should be, should be going to our brain and our muscles for repair during the night. And if it's down in our gut, it's in a way very detrimental. I think it'll be very interesting to also see, I know you, you guys are, are tracking predictability of illnesses, predicting the onset of an illness. And I think there's actually a lot of value here. We've noticed through the years that we, we measure several markers of inflammation. I'll just bring up one, which is HSCRP. And we, we see our patients, they get their blood drawn about no two weeks before we see them. And I'll, I'll be a prognosticator. I said, you got sick a couple of days after you got your blood drawn. And they said, yeah, you know, how'd you, how'd you know that? And I said, well, your, your C reactive protein and your fibrinogen was up. And they said, well, but I wasn't sick. When I came in, I wouldn't have come in. I said, well, I know, but it was actually happening in you. And we saw it in your blood work. But then it, you know, it appeared. And I think you guys are now getting pretty good at, at showing, you know, previews of something's happening that you may not be aware of. Is that correct? Yeah. Yeah. And this is, this has been some phenomenal work that has been done by, by researchers across, you know, many institutions over the last couple of years, and also a lot of work that we have done at ORA that has, that has shown that there is really some predictive power in, in, in these metrics. And one of the, you know, the, again, going back to this idea of building your baseline, which is what basically we do, right? When you get an order in the first couple of weeks, you're building your baseline. And then that baseline evolves with you, right? It's not a static baseline. And what that enables us to do is to look at these small changes, you know, that are occurring relatively your baseline, give us an idea of something might be going on. And when we see these changes that happen consistently, right? Like, so today there was a little bit of change. And then tomorrow there was slightly bigger change, you know, that tells, you know, that has the power to actually, and we've seen this association that we can, we can see two and a half to almost three days ahead of the time you start feeling symptoms and go get a test, right? We can't say whether you have COVID or flu or, you know, what illness it is, but we do see that there's something stressing your system. And that, you know, you may be coming down with an illness. This was something that actually, I think it was a, there was a Finnish entrepreneur in like March 2020, who was traveling in Europe, right? So this was early days of COVID. And one of the things that he noticed was that the readiness score was in like 50s. And his typical readiness score, it was used to be like 80s or 90s. And, and he also noticed that there was about one degree Celsius, like 1.8 Fahrenheit increase in his, in his temperature deviation, right? So he put those two things together, went to get a COVID test and tested positive, right? So that was like the first known case of somebody who looked at their aura data, thought something was off, even if he was feeling fine, he was not feeling anything specific. And then, you know, he obviously developed symptoms and, and then there have been several large studies that was a massive study at UCSF called Tempredict with more than 65,000 aura users participating in that study, contributing their data. There was a 10,000 person study that the Department of Defense did with the Defense, the Defense Innovation Unit. And also a large study that was done at West Virginia University in the Rockefeller Institute, Neuroscience Institute in about, I think, a thousand or so healthcare professionals. And all of these studies have consistently shown the ability of, you know, data from the aura ring, having this sort of predictive power. And we've actually built up a, a commercial solution that, you know, organizations are using, MBA was using during the pandemic, you know, to manage the risks of spreading infection. So I think this is, this is really fascinating. Again, an area where the science has literally kind of built up over the last two, three years. But what the potential is, is quite fascinating. And, and, you know, you could, you could, you could imagine a scenario. There was a, I think there was a paper in Lancet recently from the Scripps Institute where they, where they were talking about how data from these types of wearables could be used as, as a, as a sort of early warning sign of potential pandemics that could be spreading, right? Just by looking at these patterns of people coming down simultaneously, you know, in regions, you know, that could be some really powerful applications in the future. I think from my standpoint, I actually am impressed with the power of vitamin D to break viral illnesses. And I think if we had that sort of data that, hey, there's something about to happen to you, let's preemptively go after it with, for instance, high dose vitamin D, which is what I do. But I'm not saying everybody should, but that's what I and my family and my patients do. But, you know, getting this information early and then acting on that information, I think is even more powerful as we go towards personalized medicine. Exactly. Yeah. And a big, big, big role that we think we have to play at aura is, is in health education. So yes, we are, you know, health tracker, and you can look at your data and all that. But ultimately, what we're doing is helping you, you know, educate yourself about your health, what these metrics are, how they relate to your health, and how we can make better decisions. And I think that's sort of a larger, if you think about a larger sort of vision, that's essentially what, you know, and I think it's going to be fascinating to see people become more aware and, you know, use the data that we are capturing with ordering in these ways that are going to be quite fascinating from the future of health perspective. Yeah. The next episode of the Dr. Gundry podcast is waiting for you now. Believe it or not, some of the best ingredients, nutrients in citrus are actually in the white pith. That's the stuff that you peel off and throw away.