Vagus Nerve Stimulation: Modulating the Parasympathetic Response

- A core component of the parasympathetic nervous system. The vagus nerve is involved in a vast array of crucial bodily functions, including control of mood, immune response, digestion, and heart rate. The vagus nerve helps to modulate the body's response to stressors, supporting autonomic regulation and returning the body to a calm baseline after a stressful event. Research implicates vagus nerve dysfunction as part of the pathological puzzle for conditions like IBS, chronic pain, depression, and PTSD. - The vagus nerve has a branch that goes down to through the celiac ganglion to the spleen, and causes the T cells to release acetylcholine on the macrophages and microglial cells in the spleen, and that can inhibit the production of pro-inflammatory cytokines. There's actually this whole reflex arc that's been described called the cholinergic anti-inflammatory reflex that could signals to the brain there's inflammation, and the brain then says, okay, turn off, dampen it down. - On this episode of Pathways to Wellbeing, we welcome physician and clinical researcher, Dr. Peter Staats, to discuss advances in vagus nerve stimulation, including natural methods for restoring parasympathetic balance. We're so excited to discuss how functional medicine practitioners can use these methods to help their patients. Welcome to the show, Dr. Staats. - It's my pleasure. Thanks for having me. - Well, I think all of us are seeing research emerging about the vagus nerve and vagus nerve stimulation, and it's really compelling. And we know that you've had a long career helping patients to address chronic pain. So to get us started today, I thought it would be helpful to learn a little bit about how you got involved in this type of work and vagus nerve research specifically. - Well, thanks for asking. I mean, I got started many, many years ago when I started the division of pain medicine at Johns Hopkins University. And I was particularly interested in how electricity can help control pain. And I became the first anesthesiologist with surgical privileges to implant devices, peripheral nerve stimulators and spinal cord stimulators for management of pain and mobility disorders. And that was a very, very long time ago. And over time, my interests have morphed from just peripheral nerve stimulation and spinal cord stimulation, to taking a look at the other big nerve, which is the vagus nerve. My history is actually quite personal. I had been President of the Neuromodulation Society, and had learned a lot about how we could use electricity to improve dilation of the coronary blood vessels in cases of hemangioma when I learned that my son had peanut allergies. At that time, it wasn't really known what the innervation of the lung was. And we went to work trying to figure out how to bronchodilate somebody if they are in a state of anaphylaxis or airway reactivity. We figured it out, and it turns out that it's the vagus has a lot of control over the lungs. So this started with a very basic scientific project, which had its roots in a very personal story for me. - Mm, I can see why you'd be highly motivated to do this type of work. For those who maybe it's been a while since they were in anatomy and physiology class, will you review, just do a quick overview of the vagus nerve and talk to us about how it contributes to our parasympathetic nervous system? - Sure, so I'm going to step back a little bit and just describe where this sets into the whole nervous system. - Yes, please. - Your body really has three nervous systems. It's got the somatic nervous system, and that allows you to interact with the outside world, to touch, to feel temperature, to feel the desk that you're sitting at, to be able to walk, to ambulate. That is this somatic nervous system. There's two other nervous systems. One is the enteric nervous system, and some of your listeners will know about the enteric nervous system, and that's the nervous system that kind of covers the gut. And then there is the autonomic nervous system, which is largely made up of two branches, the sympathetic and the parasympathetic. Now, everybody's heard of the sympathetic nervous system, the fight or flight nerve. But what's less appreciated is that there is a parasympathetic, a counterbalance to the sympathetic nervous system. And that counterbalance is the rest, relax, and recovery. This nervous system is so critically important in many physiological functions from your cognition to your gastrointestinal tract. It really controls the internal workings of your body. And until recently, we've not really known how to tap into it. I would say, you know, in fairness, there were people 4,000 years ago who had kind of started to suggest this with acupuncture and other therapies like that that probably tap into the vagus in part. But modern medicine has re-figure this out since the late 1990s. - I remember being in school and working with our cadavers, and learning about the vagus nerve as the wandering nerve. Will you tell us a little bit, why is it called that? - So the vagus nerve is the only cranial nerve that leaves the head and the skull area, it drops through the jugular foramen, comes down through the carotid sheath, it then spreads out and controls lung function and cardiac function, continues to drop down on the inside of the chest and pop through the diaphragm. And then like a spider web, it just spreads out over all of the visceral structures in the gastrointestinal tract. So this would include GI motility, the pancreas, control of insulin, et cetera. And so there are so many structures that this nervous system is controlling. About 80% of the nerve fibers that come back send signals to the brain about what's the status of the organism from, are you hungry, to is there infection going on? And it sends information back up. And what's been recognized recently is that the brain then says, aha, there may be issues here. Let's control and let's alter the function of the organs with 20% of the information coming back down. And so that cycle, that information coming in and going out is almost all controlled by the vagus nerve. - Okay, so we're starting to put this puzzle together of why the vagus nerve might be implicated in conditions like IBS, but then also depression and PTSD. - Yeah. - And immune function, and allergic response, and bronchodilation. - Yes, it is the command and control of so many things that we just take for granted. But it has critically important in many, many different functions. And I think this is one of the reasons the functional medicine community wants to embrace this. I started thinking about this a little bit differently lately. You know, I consider the human body and the electrical chemical organ. And many of the things that we've been doing over the last hundred years, I'll say a thousand years honestly, has been providing drugs to control receptors or modulate receptors to control symptoms, and sometimes control diseases. But that really is only part of the story. Another very important part of the story is the electrical side. The electrical side is every bit as important as the chemical side, but it's not received the attention that it needs. And that's really where the, a lot of my research has been over the last, you know, 20, 30 years. - When you, you know, 30 years ago started doing this work, and you found all these connecting points between body systems, have you been surprised by all of the processes or disease states that the vagus nerve might be related to? - Well, definitely. I mean, when I got started, I was very simplistic in my approach in looking at the, you know, the lungs. But then when we were treating patients with asthma as part of our original studies, some of the patients reported that my headache went away. So we then went off and studied headaches, and we spent an more enormous amount of effort studying headaches with several thousand people in clinical trials and headaches. But, you know, full circle, COVID hit. And I knew that we could modulate cytokines, and I knew that we could bronchodilate. So we got the first emergency use authorization for acute treatment with COVID, because there was really nothing else that was out there at the time. So the research has taken us into post-traumatic stress disorder, to airway reactivity, treatment of diabetes and obesity, and gastrointestinal motility disorder. So it really has been very, very broad. One area that I found interesting is that we are missing the boat on our diagnosis quite frequently. And that's something I think the IFM team can, in particular, particularly appreciate, that we tend to be splitters in this world. If you come to see me with anxiety, I'll send you to the psychiatrist. If you see me with depression, we go off to the psychiatrist. If you have migraines, you go to see the neurologist. If you have fibromyalgia, they'll go to the rheumatologist. And nobody really stops to think, okay, what's the root cause here? What's causing all of these problems in patients with multimorbidity disorders? And maybe about 10 years or so ago, I did a study, I did two sets of studies looking at a statistical analysis of patients with multimorbidity, and found that there is in fact a latent causation for these different problems. What does that mean? Patients who have multiple different problems don't have a migraine that causes depression or vice versa. There's something that is underpinning these sets of symptoms from fibromyalgia, to anxiety, to sleep disorders. And I've called that vagus insufficiency syndrome. And you can see clues of that in long COVID. But we've known about these problems. We've just not labeled it as such. We've just called them patients' crazy. But in fact, I think there's an electrical problem. I think there's a problem with the vagus in many of these patients. And if you reflect back, many of the patients had had a viral infection that happened predating their symptoms. Other people have had an automobile injury or some type of fall that could have damaged the vagus nerve. And I think we're going to be, we're on the cusp of understanding that there is a new diagnosis out there called vagus insufficiency. So I challenge your audience here. Go take a look at the most complicated patients that you see, the patients with anxiety, depression, migraines, gastrointestinal problems, maybe asthma. You take a look at these really complicated problems and see if you can't track it back to a possible damage to the vagus. And one study that we did was a very simple study, took patients with migraines plus, and we treated them with vagus nerve stimulation. And not only did the migraines improve, but the secondary symptoms seemed to go away. The secondary consults started to go away, the imaging studies started to not be needed anymore. So we have a lot more work to do on this, but this is an area by how you think about things will reflect what you actually see. - Hmm, this is so well aligned with the functional medicine model, just like you mentioned. I mean, in our foundational teaching, we try to convey this concept that oftentimes there's a single underlying factor that manifests in different ways in different people based on all these kinds of variables. And that's so well aligned with what you just said. So my clinician brain, it has to wonder, I mean, as I look for the type of patient that would benefit from some kind of support in this area, it's hard for me to think of anyone who doesn't need help with their vagus nerve. How do we identify the people that really have dysfunction? - Well, first of all, I would think about, let me just say, first of all, I don't know the answer to that question. Unfortunately, I've only been studying this for 30 years. But I would say a few things. Number one, take a look at patients who have found to be responsive to vagus nerve stimulation. So anxiety, depression, fibromyalgia, migraines, cluster headache, and take a look at patients who have multiple disorders that all track back to the vagus. That complicated, complicated patient actually does pretty well with vagus nerve stimulation. Second thing I would say is it's extraordinarily safe today to offer patients vagus nerve stimulation. Even the United States Air Force is using one of the devices that we developed to enhance warrior and airmen readiness. They found that a normal person has better cognition, able to learn better, can learn a new language quicker, can learn to land the F-15 jets in their simulators quicker. There is less fatigue, there is less errors with the drone operators. So normal people or super soldiers can become super duper soldiers. So on the one extreme, everybody can benefit from this. On another extreme, just think about the very simplistic, you know, do we want to use drugs for a patient with migraine, or do we want to use electricity for a patient with migraine? And I think that the spectrum in between is really quite broad here. - Oh, so interesting. Okay, so as we're thinking about the vagus nerve, I've now heard you say vagus insufficiency, right? And we use vagal stimulation as a treatment. So I'm wondering, is the issue that we have under activity of the vagus nerve, or is it that the sympathetic nervous system is so active? Or is it a combination of both maybe? - So the answer is yes. - The answer is yes. - So look, the first thing I would say is, in today's world, we are under constant stress, under constant threat from, I've got this project due, to my spouse is yelling at me, to my kids got a C in school. We're always worried, we're always the state of sympathetic overdrive. We need to actively try to get into parasympathetic, or rest, relaxation, recovery. Now, teleologically or historically, I kind of think of us as hunter gatherers that would be sitting out in the fields gathering, or you'd be occasionally going on a hunt. But most of the time, our ancestors were in a state of parasympathetic overdrive, parasympathetic, you know, tone. Once in a while, you'd have to run away from a saber-tooth tiger or a bear, or somebody who's chasing you. But the amount of time in sympathetic versus parasympathetic was just reverse of where it is today. We need to actively work to get us into a parasympathetic state where we are rest, relaxed, and recovery. And that's metabolically better for ourselves. It's metabolically better for mitochondria. It's been shown to improve inflammation as you've indicated. So there are so many reasons to do this, and however you do this, I think it's important. I've developed a biohack, but you know, cold water immersion, deep breathing, pranamaya yoga, there are many different strategies that people have developed over millennia to try to activate the parasympathetic nervous system, to activate the parasympathetics, to spend more time in rest, relaxation, and recovery. And we've seen health benefits just across so many different disorders with doing this. It's really important to integrate this into a functional medicine paradigm, to be part of our thought processes, part of our root cause analysis, which it's a term that I heard from you guys first, is what's the source of this problem? And sometimes it's, okay, I've got a vitamin deficiency, or I've got a protein that I need more of. But I think a big portion of our evaluation is going to find that it's an electrical problem. It's a problem with the vagus. And just should be on the front of your mind when you're seeing patients. Could this be an electrical problem, or is this just another chemical problem? - Well, I mean, we've mentioned a couple times in this episode that the vagus nerve, part of its function is to help us recover from these stressors. Like you said, you run from the saber-toothed tiger, but then you kind of go back to your baseline state. When I'm talking to patients, sometimes I'll say, if you have to slam on your brakes in traffic, are you like, ooh, that was scary, and then you move on, or does your heart beat, and you're, you know, very anxious for the 40 minutes until it takes you to get home. Just to get a sense of what that recovery and resiliency is like. It seems to me that the longer we're exposed to these chronic stressors, we become so much less resilient, and it's harder for us to make that recovery. Is that something that you see in your patients that have vagus dysfunction? - Yeah, I mean, I think so. A part of the original vision of vagus dysfunction was more of a traumatic injury. And that can come with a viral infection, can come more with, you know, automobile accident, where there's actually a damage to the vagus that can later be identified. And in some of the work on long COVID, for example, they have these constellation of weird symptoms. It's estimated that 70% of patients with long COVID have had a damage to their vagus during, with this viral, you know, infection. So, boy, I forgot where I was going with this whole thing here. But so two aspects would be virus and injury. And a third aspect I think is psychological trauma. We definitely know, one of the first things I learned as a pain physician was that one of the predictors of the development of chronic pain is early childhood abuse. And a guy, Steve Porges, has come up with what's called the polyvagal theory that suggests that there is a damage to the vagus cell bodies such that the dorsal vaguses kind of takes over. That's the fight or flight, that's the freeze portion of the vagus. And I think that this whole model of vagus insufficiency needs to incorporate, you know, psychological trauma, physical trauma, viral trauma. Maybe we will find, you know, deficiencies in diet, et cetera. But I do think that this structure is really important and can serve as a foundation for integration of all these different areas that we kind of are piecemeal out there about, you know, diet. Well, how does diet improve serotonin? Well, it's through the vagus. You know, how, you know, sleep disorders, we know that sleep is so important, and healthy lifestyle, well, that's controlled by the vagus. So there's so many things that come back to the vagus when you actually stop and think about it that it just should be part of your thought process. And again, I sound like I'm an only vagus guy, but I'm not. I just think that this is one big important piece of the puzzle. And if you're putting together a jigsaw puzzle, the four corners, two of them might be the vagus, and then there's so many other areas as well. This should just be foundational in how you think about evaluating a patient. - Something that's really coming forward for me is, let's say someone has chronic inflammation, and we're just asking them, we're probably looking at, oh, what's your diet look like? And do you have maybe insulin resistance? You know, these things that are kind of low hanging fruit. But it really is this invitation to go back and look at, do you have some infectious trigger? What was going on with your, do you have some adverse childhood events? It's this opportunity to dig a little deeper, which I think is really what functional medicine is all about, and I really appreciate that. - Yeah, so I'll just riff on that for just a second, is, you know, inflammation has been shown to be part of everything from cancer, to asthma, to diabetes, you know, and I actually can't think of anything that inflammation's not important than. - Right. - But acute infection and acute inflammation can be valuable. If you get a bacterial infection, your body needs to know to fight, and mount a response against that acute injury. But rarely is chronic infection, chronic inflammation helpful. And because of that, your body actually has developed four methods for inhibiting or dampening inflammation. There's cortisol, and we all know about that. There's pro-inflammatory cytokines and anti-inflammatory cytokines. So your body has some anti-inflammatory cytokines. There's the JAKs proteins. But the key one, command and control is the vagus. The vagus nerve has a branch that goes down through the celiac ganglion to the spleen, and causes the T cells to release acetylcholine on the macrophages and microglial cells in the spleen. And that can inhibit the production of pro-inflammatory cytokines. There's actually this whole reflex arc that's been described called the cholinergic anti-inflammatory reflex that could signals to the brain there's inflammation, and the brain then says, okay, turn off, dampen it down, like a thermostat will just kind of slow it down a little bit. But if you don't have adequate vagal tone, your body doesn't turn off the inflammation adequately. So while I am entirely aligned with the functional medicine team about, okay, how do we get our inflammatory markers down through diet and, you know, other strategies, it's important to think that your body has a way of doing that, that we can help it along with, which is the vagus, that's been established now for 25 years that we've known that the vagus controls inflammation. Now, originally it was described in the spleen, but we've described the same anti-inflammatory reflex in the GI tract, for think about inflammatory bowel disease, and Crohn's disease and those types of disorders. There's studies that have been shown done with implanted devices showing that we can, shall I say, cure Crohn's disease when biologics have failed, because they're decreasing the inflammation through the body's natural method using electricity. And we can find the same anti-inflammatory reflex arcs in the brain, in the pancreas and other areas as well. But important to recognize that we all recognize inflammation's important, but how do we get it under control? Diet, yes, but your body does it with electricity. And we need to incorporate that in our thought process in evaluating a patient. - Well, and there's something really powerful about that narrative, if we think about the locus of control is maybe I don't always need these external things, you know, the supplements, that my body is inherently designed to do this work. I just need to give it the tools - That's exactly. - That are necessary. So let's talk about that a little bit about what are we actually going to do? What I would love to hear, you know, not all of us are going to go right to implantable devices, right? There's certainly so many things we can do to support the vagus nerve. - Yeah, that's right. - What are the things you start with? - Okay, so first thing I start with is an understanding that the threat is not external. The threat is internal. So when you're perceiving your external world, how you interpret it is going to create that as a threat or not. So, you know, if I'm doing a big interview with the famous Kalea Wattles, and I'm doing this big interview, I can choose to get nervous about that the day before and be all stressed out. Or I can choose to say, well, at least I can't kill anybody today, and you know, this will be a fun interview. We'll have some fun together, we'll talk about it. And it's not threatening to me because of how I've chosen to understand it. So it's a very basic thing in interpreting the world around you and not be threatened. That's not always possible, but do your best with that. Second, there's a lot of normal methods that are out there that have been shown to work in many different ways, may not always have recognized that this is a vagus stimulation. Deep breathing, box breathing. Four seconds in, four seconds hold it, four seconds out, and start over again here. So there are ways of doing this controlled breathing. Cold water immersion, putting your face in cold water, part of the mammalian diving reflex has been shown to activate the vagus nerve. Exercise, I tell all my patients to exercise because that's been important in activating the vagus. It's good for everything, but it's, you know, also activates the vagus. If I didn't mention pranamaya yoga and other types of yoga, those are shown to activate the vagus. So there's a lot of things that we can do on the spot from internal locus of control, to tuning in our body and understanding what our body is telling us, and activating the vagus. Meditation's another one. And you know, I unfortunately I'm not very good at meditation. But if you're a Tibetan monk, you can activate your vagus and control your heart rate and heart rate variability really quite well. And I'm a fan, so like, if you can do that, that's great. The devices that I've built are really for mere mortals who can't do all of these things, or have a, don't have an ice bucket in their office that they can stick their head in frequently. Two minutes of non-invasive vagus nerve stimulation in the neck, or in there's devices for the ear as well have all been shown to modulate heart rate variability, activate the vagus, optimize, rest, relax and recovery. So there's, starting with just how you think about things, through what your behaviors are, through external devices that are non-invasive, that are very safe, that don't require surgery, are all things that we should be thinking about. - So let me, I'm going to dive into a couple questions I have here. Let me go back to, you know, the things like the cold water immersion, just kind of dipping our face in some cold water. Or even the deep breathing. Are these things that we should be doing when we feel our stress response ramping up, and or is it things that we do, you know, we wake up in the morning and we just have these ritual. If we do these things to kind of keep our nervous system healthy, do we know, is it that specific? - Yeah, I think you can do it prophylactically, and most experts in yoga, meditation, et cetera would say do it every day. But I also think it's important to be in tune with your body and understand when it's, you know, we'll call interoception, we start to note that I'm getting this funny feeling in my stomach, or people all feel it and can have different organs targeted, so to speak. But when you start to feel yourself becoming anxious because your stomach's in, your muscles get tight, great time to intervene, stop and do whatever intervention you do to try to get yourself and the parasympathetics under control. So the answer is yes, both. I would do it prophylactically, and I would suggest doing whatever intervention you do on the spot. So with some of the devices that I've worked on over the years, we have devices that work to prophylax and stop a migraine from coming, prevent migraines. But if you feel a migraine coming on, you can use it as an acute treatment as well. And these are studies that have been FDA approved, looked through by the FDA and granted, you know, clearances for acute treatment as well as prevention of migraine. So in summary, I'm saying, yeah, both are good and we should, each person is different and individual, some people just need to have a baseline improvement. And then some people need a tool when events get out of control for them. - Well, now I have to tell you about my end of one experiment that I did on myself where I took my blood pressure, and then I did humming exercises. - Yeah, yeah. - Toned the vagus nerve and then I rechecked it, and it had quite a profound effect actually. - Yeah, so it really does. And I should have thrown that as another one, which is there's a whole school of thought on music interventions. Humming activates what's called the recurrent laryngeal nerve, which is a branch of the vagus, right? So it's kind of funny how this all kind of comes together, but facial expressions, and humming, and singing all can be shown to activate the vagus. That's an important aspect of physiology. There's another aspect that's really, I think interesting to me is there are music patterns that have been shown to activate the vagus. There's a, Steve Porges, who I mentioned earlier, came up with safe and sound protocol, and he's got a new one now that's working on activating the vagus by training the body's nervous system to internally activate the vagus. So they're so many different unknowns here, and pieces of this journey that we're going to be figuring out. - Well, you mentioned, I think a lot of the commercially available devices that I've seen. There's some activation around the neck or the ears like you said. Will you just remind us of the physiology of why those things might be helpful? - Sure. So there's about 160,000 fibers, give or take, left, right, maybe a little bit more. But you know, roughly speaking, you have more than 300,000 fibers going up and down in the neck, 160,000 on either side. There's about 1,000 fibers that come from the ear to the trigeminal islands in the brainstem. So these fibers run straight up to the jugular foramen, enter the nucleus tractus solitarius. There are 80% afferent fiber, so they're giving us information about the body, 20% efferent fiber. So this control can be accessed in the neck here. There are efferent fibers as well, I'm sorry, excuse me, purely afferent fibers from the ear that come in, and a thousand, and they come in pretty close to the nucleus tractus solitarius. So these are really important structures. Information from the nucleus tractus solitarius goes up into the brain, and goes to all kinds of different areas, from the nucleus accumbens and other areas like that that are important in treatment of addiction, and treatment in anxiety and emotional control. All of that information tracks back through this area called the NTS. So for central structures, the vagus nerve gets its information through the NTS, but for visceral structures, there's so much information going out controlling the bodily function that it's done this way. So two main approaches are cervical non-invasive, and then there's auricular devices that probably have a relay station in the brain, but they also can control peripheral functions as well. Both have been shown to be effective. I have a bias that the cervical region, if you're stimulating just the vagus, is a better approach. But there's a lot of researchers working on the auricular as well that are showing pretty good effects. - Hmm, and do I have my understanding correct that maybe this is helpful, like you said, for people that have migraines, but also for the person that just gets really overstimulated and anxious during their workday because of all of these inputs, like this is good for a variety of purposes, yeah? - Yeah, so this, I haven't found a reason that not to use it for the most part 'cause it can be so helpful for so many people. Now, that's not, that's very different than me saying this works for everything. But, you know, we're at the beginning phases. We're at the tip of the iceberg of understanding where to use this clinically, as well as for wellness approaches, because it really should control a lot of physiological functions that can go awry in the normal course of life. - Something I'm really grateful for about this conversation is connecting the science to things. I'll give you an example. Sometimes when I'm talking to patients who have this chronic inflammation, and I can't figure it out, I really truly think that there's a connection to their nervous system. But when I'm trying to make that connection, they're like, wait, so my hs-CRP being elevated is somehow due to me being overstimulated answering emails all day? And yes, I really do think there's a connection in this discussion is such a powerful illustration of those connecting points. - Yeah, I think so. - Thank you for that. - Yeah, no, it's interesting. I think that we're in the midst of what is a paradigm shift of us thinking about human physiology and disease management. And what do I mean by that? For a thousand years since Avicenna's Canons of Medicine, which is the laws of medicine, almost every effort has been directed at giving a drug for a symptom or to modify a disease. Almost nothing has been towards the electrical side of things. But there is this intricate dance between electricity and chemicals that occur in every thought that you have, and every disease process that occurs. We have not been thinking about electricity as part of the solution here. And I think we're on the verge of a switch. And let me describe a couple of other things. The most effective thing that we have for managing back and leg pain right now is a spinal cord stimulator, electricity. The most effective thing that we have for managing bradycardia and arrhythmias is a pacemaker and a defibrillator, electricity. The most effective thing that we have now for managing things like urinary incontinence is a sacral nerve stimulator, electricity. When you start to put this all together, I think it's fair to say, electricity in the human body is kind of important. And how do we harness that? And we just need to get to the right frequency and the right nervous structure to harness this. Einstein said in 1934 that the future of medicine is the future of frequencies, and that the future physician will be the master of chemical and the electrical side, or he said physical side, but he meant electrical side of man is what he said. Obviously it's men and women, but that's what he said. And I think we're on the precipice of really embracing the concept that electricity, that we are electrical beings, and we can cure diseases, cure diseases with electricity, as well as control a variety of symptoms. And interestingly, possibly even make us better human beings with the use of electricity. And what do I mean by that? You know, if you go on YouTube, you'll find and look up Black Swan, Dawn of the Super Soldier, you will find a video of a report of the United States Department of Defense talking about how they're using vagus nerve stimulation to improve the function of our soldiers, the readiness of our soldiers. So, electricity, subtotal electricity is important, and it's going to turn out to be important in how we think about our wellness, our readiness, our illness, and we just need to figure out a better ways of harnessing it. - This may be really related to what you just said, but I mean, we know you've been doing this type of research for 30 years, and you said there's still so much to learn. If you look ahead into the future, what's next for vagal nerve research? Is there something that you're excited about or that you hope someone will research or you'd like to research? - Well, yeah, I mean, I think we need to be, you know, there's different ways of answering that. The first is we've got big trials going on in post-traumatic stress disorder. Long COVID was another area where, by some estimates, 3% of the population has long COVID. And we are doing an awful job of treating that with a very poor understanding of what long COVID is. So I think, you know, there's the tried and true areas. A second area I think is we're going to follow through on this concept of vagus insufficiency, and we're going to make new diagnoses that are out there of people who are very complicated and very expensive to society. And we're going to figure out that there's a new disease out there that is an electrical disease of insufficient function of the vagus nerve. Let's see, I would say that those would be two of the areas where I think, you know, are really exciting. And then the third area that I'm beginning to look at right now, and have just published on is the possibility of curing diabetes with electricity, electrical stimulation. So that's really at the beginning phases, but this is a really exciting time when we think about the diabesity epidemic and the obesity epidemic. Maybe it's not just insulin release, but it's an electrical phenomenon that controls insulin release, and inflammation that we can know that we can control. So I think there are big, big questions that will require answers, and part of the answers are going to be harnessing the vagus in some capacity. - Well, how exciting. - I have a documentary coming out on hacking the vagus nerve that will be premiered at the IFM next week, I think, which kind of starts to tease out some of these different science aspects, clinical utilization, and the future promise of harnessing the vagus. - Well, I mean, considering all we need to do to treat chronic disease worldwide, this is so exciting. So inquiring minds want to know, what are the things you're doing to take care of your vagus nerve on a regular basis? - Well, I would say, you know, I could always be better. I'm just like everybody else. I wish I were better. But you know, it starts with exercise every day. It starts with trying to reframe the world around me, and cognitively, and not getting upset when things happen. And, you know, sometimes people push my button, I get upset, but I do my best to not let that happen. Do as good of a job as I can with my diet. Sometimes I can be better, but that's something that's been shown to work. And then electrically stimulating the vagus nerve as well. - As we conclude this episode, is there an a takeaway or a theme that you'd like our listeners to leave this episode holding in their mind? - You know, I think the episode or the theme is that we are in the midst of a paradigm shift. Much like when Darwin, you know, recognized that there's these bones out here that don't seem to make sense, that they've become extinct. And then there's chimpanzees, and may have had a common ancestor at some point in time, and it took just kind of looking at the world a little bit differently. I think we're on the precipice of this, and where we're thinking now we should be thinking about, beyond chemicals, but incorporating electricity, and just recognizing what's right in front of our face, that the body is a bioelectrical being. And don't just think about drugs, think about electricity in marrying the two to do the best you can for your patients. - Hmm, beautifully said. Thank you so much for sharing all of your clinical insights today. We're looking forward to the work you have coming up and learning more from you. It's just been a pleasure chatting with you today. Thank you so much for your time. Thanks. It's been a pleasure. Thank you. - To join the conversation on this topic, visit IFM's pages on Facebook and Instagram. For more information about functional medicine, visit ifm.org. The future is functional.