594: The vagus nerve could revolutionize how you heal your body & mind | Kevin Tracey, M.D.
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So you've probably heard of the vagus nerve in the context of breathwork or meditation, but its influence on health goes far beyond relaxation. Today's guest, Dr. Kevin Tracy, has spent decades uncovering the groundbreaking potential of the vagus nerve and his discoveries are reshaping how we think about inflammation, immunity, and healing. Dr. Tracy is a neurosurgeon, scientist, and entrepreneur whose research has revolutionized our understanding of the body's built-in healing mechanisms.

He's the pioneer behind the inflammatory reflex, a discovery that reveals how the vagus nerve can control inflammation, and in some cases, even reverse diseases like rheumatoid arthritis, IBD, and Alzheimer's. In today's show, we'll explore the science behind the vagus nerve, its crucial role in regulating your body's vital systems, and how simple lifestyle strategies like breathwork, exercise, and even cold exposure can enhance its function.

Plus, we'll discuss the cutting-edge potential of vagus nerve stimulation, how this emerging therapy is helping patients reclaim their health. Dr. Tracy's new book, The Great Nerve, sheds light on the fascinating field of neuroimmunology, showing us how we can tap into our body's own intelligence to optimize health, combat disease, and extend longevity. This conversation is packed with eye-opening science and actionable takeaways, so let's get to it.

So let's start with a primer on the vagus nerve. Well, there's textbooks explanations and there's long mythological explanations and there's what it really is. So let's break it down really simply. The vagus nerve is a crucial communicating nerve between your brain and the organs of your body, all the organs you never think about. It's the longest nerve in your body. It is the only nerve in your body, if you cut it,

you die. So it's fundamentally important for many reasons. It's not a vagus nerve. You actually have two, one on each side, like you have two thumbs and two kidneys. And it's not really fair to think about it in the singular because you have 100,000 vagus nerve fibers on each side of your body. And so it's a massive communication problem.

stream that carries signals from the body to the brain about the status of all of its organs.

And from the brain back to the organs to control how they function in a balanced, healthy way. So that's the vagus nerve. And because we have 200,000 fibers, the complexity of what each of those fibers does is enormous. And we know a lot about the vagus nerve today, but we're still in the early days of learning everything about it. So how does one assess their baseline? Yeah.

to understand if they're properly optimizing it or if it's working properly.

For cardiovascular health, I can go do a CLEARLY test and do a whole set of cardiovascular labs, get an understanding of my baseline cardiovascular system. What about here in this situation? When we think about assessing our own vagus nerve health, there are some simple measures that offer a good place to start, and there are some complicated measures that can only be done in laboratories.

And whether it's simple or complicated, we're only scratching the surface of what we understand about vagus nerve health. Because as I said already, it's not that you have one solid copper wire called your vagus nerve. You actually have more like 200,000 individual wires carrying all these signals. So to put the complexity aside for a second and ask for simple measures, a simple measure of vagus nerve health

is sometimes called vagal tone or vagus nerve tone. And that can be found by checking your pulse. So how does that work? Well, heart rate, the speed of your pulse, is determined by a balance between signals in the nervous system that travel in the sympathetic nervous system, which tend to accelerate heart rate. And those nerves travel to

your heart to send the speed up signals and signals in the vagus nerve, which carry signals from the brain to the heart and they carry the slow down heart rate signals. Now, what's interesting is, and this is good news for those out there with a very slow heart rate. If you look at population studies, one thing that statistically correlates to the longevity of a population

is actually heart rate. So populations with slower heart rates tend to live longer than populations with faster heart rates. Now, this has been true in the Framingham study outside of Boston, and it was true in an enormous study in France that looked at thousands and thousands of patients over many decades. So when the vagus nerve sends electrical signals to the heart, those are converted to chemical signals, and those chemical signals

cause the beating heart to pause. It prolongs the time between individual heart rates. And you can measure that somewhat crudely by checking your pulse. And you can measure it in a more sophisticated fashion by analyzing longer traces on electrocardiograms. And that's the basis, that kind of

That kind of analysis and those kind of algorithms are what are built into many of the home health monitors like Fitbits and iWatches. Yeah, I like that. I wear wearables. I'm wearing my Whoop, my Oura ring. So anyone wearing a wearable, whether it's one of those or Fitbit or Garmin, a lower resting heart rate and probably higher HRV. If you're going in the right direction on both, you're probably doing okay. But if you think there's an opportunity, your vagus nerve is probably...

playing a role here? It probably is. And now it gets complicated because what role is it playing? So first of all, I think we also should point out to your listeners and viewers, if they just check their pulse and it's racing fast, it doesn't mean they're doomed to an early demise, right? When you have a statistical outcome of a population effect, looking at whether it's heart rate variability or a slow pulse or a fast pulse, it can make...

important insights and predictions about the population as a whole, but you can't necessarily apply those predictions to an individual. So, you know, there's lots of reasons people could have fast resting heart rates and be perfectly healthy and live to be 105. But when you ask the question about what can we do about this and how can we optimize our vagus nerve health,

There, it gets down to when someone tells me I want to stimulate my vagus nerve, I say, really, which one? It keeps coming back to this idea that these signals that are traveling in the 100,000 fibers on each side of your neck are carrying information about digestion, about how much glucose is traveling in through your body, how much insulin, how much glucagon. It's controlling how hungry or full you are. It's controlling the activity.

Of reflexes that regulate every breath you take as well as every beating of your heart. So these signals are traveling from these organs up into the brain and the brain is processing these incoming signals. And this is happening one fiber at a time.

But once the information in an individual vagus nerve fiber gets into the brain, the brain does respond in ways that we are just barely beginning to understand.

So what can we do about it? Well, now we can get into the health benefits that are that are advocated for for general health and well-being generally. Exercise regularly to reduce stress in your life and get enough sleep. Eat a balanced diet and perhaps focus on relaxation methods or deep breathing methods. All of these things have been shown to improve vagal tone.

But exactly how they work is still open to a lot of scientific controversy. I would say what's so interesting here is, as you think about benefits and outcomes, you're essentially touching on mental health, weight management, diabetes, cardiovascular health, everything you want to be aware of.

And I think there are a lot of people out there who are doing all the right things. Everything you mentioned, they've nailed lifestyle, but you know what? Maybe their vagal tone is off. Maybe they're not as healthy or maybe they have a higher resting heart rate or lower HRV and they're getting frustrated.

And there is the cliche of stress kills, and that's very real. And they're already doing all the right things. And I think this is what's so interesting about your work and the science behind it as it relates to vagus nerve therapy. It's on the cutting edge, and there's real science behind it. So let's go there and talk about this as a therapeutic intervention, if you will, what it is. Your remarks, I think, lead perfectly into the question of these questions

folks who are doing everything they can, but they notice that from whatever measure, heart rate or heart rate variability or other autonomic measures they may have had at the doctor's office, that their autonomic function is not great. Why is that? Are these vagus nerve or brain circuits, are they not functioning properly? Well, one thing that comes to mind in those kinds of cases is inflammation.

And inflammation can cause the autonomic nervous system and the vagus nerve to function imperfectly or less precisely. And this is a really important, the knowledge of the linkage between the autonomic nervous system and vagus nerve signaling to control inflammation is a relatively new breakthrough that my colleagues and I have been working on now for some time. And this breakthrough understanding points to the fact that

The vagus nerve itself, signals traveling in the vagus nerve can suppress inflammation in the body. And by suppressing inflammation in the body, it's possible that we can derive significant therapeutic benefit in some conditions that are known to be associated with dysfunctioning vagus nerves or abnormal heart rate variability. Conditions like rheumatoid arthritis, for instance. We've seen in rheumatoid arthritis patients that their heart rate variability varies

is impaired. And very interestingly, studies looking at families of rheumatoid arthritis patients, looking at unaffected family members who are at risk for getting rheumatoid arthritis, some of these individuals start to show signs of vagus nerve dysfunction

or impaired heart rate variability before they have symptoms and signs of arthritis. So that raises the question, which is unproved, but it's a very reasonable theory that's being studied, of whether or not the vagus nerve signaling, defective or dysfunctional or impaired vagus nerve signaling, occurs

And that's why the inflammation develops in the body afterwards, because it's like losing the brakes on your car and going down a hill. It's fascinating. And look, it makes, in terms of being a leading indicator, I'll just use HRV and RHR and share. I did my own Ed of One personal experience where...

I had some cardiovascular, I do all sorts of experiments and I was experimenting with diet and I went high fat and my cardiovascular markers like went haywire. ApoB went to 110. You don't want it there. You want it under 80.

And so I did an experiment where I found out I was an ultra absorber of saturated fat. I did the Boston Heart Cholesterol Test. And so I really cut down saturated fat. No more coconut milk. We just have like low fat milk or maybe some oat milk. And you have to wait like eight to 10 weeks to do a real experiment. But what's so interesting in my wearables, after like the first week, my resting heart rate started to really drop. My HRV started to really increase.

And sure enough, when I did the labs eight weeks later, APOB went from 110 to 71. But if I looked at RHR and HRV as it relates to this conversation, they were leading indicators. Something was going very right. To your larger point, you talk about rheumatoid arthritis, inflammation of any kind. I think what we're touching on is vagus nerve health is a gateway to understanding what

inflammation more generally. And inflammation, I think, is a nebulous term. We all know it exists. We all know it's bad. But if we think about root causes...

this is an area where we should spend a lot of time. 100% agree. I could not agree with you more. And very well said. The idea of inflammation as a word actually probably needs to be revisited at some point. If you look at what inflammation is defined as, it's redness and swelling and pain associated with an injury or an infection. And the people that came up with that-

were the early Greek and Roman physicians 2,000 years ago. Now, if you look at the brain of an Alzheimer's patient, or if you look at the heart of a heart attack patient with inflammation afterwards, or other organs or other systems

If you look at the quote-unquote inflammation associated with metabolic syndrome and obesity, you don't see swelling, redness, and pain. We need probably, we're being limited now in some ways by semantics. We agree that white blood cells making things like cytokines and other mediators are critical in the pathogenesis and the progression of metabolic syndrome, obesity, diabetes, hypertension.

There are many cancers which are critically dependent, either caused by or made worse by those same inflammatory cells making those same kind of inflammatory molecules. The same is true for Alzheimer's. In fact, if you ask the question, according to the WHO list of the leading killers of the human race today, it turns out that two-thirds of

of people who die, of the 60 million people who die every year, 40 million of them die of diseases that are either caused by or made worse by inflammation. So what you said is critically important. If we could control the signals in the vagus nerve and control the amount of inflammation in people at risk of dying from inflammatory conditions,

this could have a significant impact on global health. And the scientific and clinical evidence supports that statement. That's not a wish list of some future time. What we're trying to do right now is figure out how to do that actually in people. Yeah, yes. And I think you'd agree we need to

We're world-class disease care in this country, but we're not so good at addressing root causes. And I think about root cause medicine, I think that this is at the forefront. And I'll start, you have a very provocative title for your first chapter, How Electricity Can Replace Your Medications. And you go on to say, quote,

I am convinced that bioelectronic medicine has the potential to revolutionize healthcare, unquote. We all talk about food as medicine and exercise and sleep and all these things, but electricity, this is a new one. Please tell us more. Yeah, it's time to add electrons to the list of therapies that we'll be using. And I want to point out also, you are a real medical doctor as part of one of the biggest hospital systems in America. You are not, you know...

on the fringe with some device in a weird strip mall somewhere in, you know, I live in Florida, so somewhere in Florida. Not to knock those people, but you are a legitimate practicing medical doctor of a very well-respected, one of the largest hospital groups in the country. So I just want to point that out for people. Thank you. Yes, I am. And I've been studying the role of the vagus nerve in suppressing or treating inflammation. I've been studying it for

coming up on 30 years with hundreds and hundreds of colleagues. Much of what we've discovered in the laboratory here at the Feinstein Institute in New York, much of what we discovered has been replicated now by laboratories around the world, published in our own case in hundreds of scientific publications, and in the case of my colleagues, thousands more. So this is not fringe anymore. What we've learned

is that specific nerve fibers, the ones we've been talking about of those 200,000, probably a few thousand, their job it is, is to turn off cytokine storm. Cytokine storm is what occurs early in inflammation when white blood cells are activated

to release molecules like TNF and IL-1 and IL-6. Now, many of your listeners have heard of these molecules or seen them advertised on TV because those molecules are the drug targets for the class of drugs called biologics. And so in patients with severe autoimmune or inflammatory conditions, they take drugs

which are antibodies or receptors that are injected and mop up or stop the activity of these molecules like TNF. Well, what my colleagues and I discovered is that we can implant a computer chip, which stimulates fibers in the vagus nerve,

to take those signals which turn off inflammation. And what happens is it turns off the inflammatory cytokines and it reduces the inflammation in rheumatoid arthritis patients. We've done many, many laboratory studies to map all the very specific nerve fibers that do this job in the vagus nerve. And we've mapped the molecules they use to talk to the white blood cells. And we've mapped inside the white blood cells

We've looked at how the signal goes from the cell surface and then the nicotinic acetylcholine receptor all the way into the nucleus to shut down the transcription of genes in the white blood cell that caused the inflammation. So we've worked it all out. And that really culminated in a series of clinical trials. The first, which we published in the Proceedings of the National Academy of Sciences, is

about eight years ago or so, was a clinical study in rheumatoid arthritis done in Europe, which showed patients had significant benefit. And many of these patients had not derived benefit from these biologic drugs, you know, best-in-class treatments. So the reason that I'm so confident is twofold. First,

Just last fall, November, the company that I co-founded almost 20 years ago, 18 years ago, Setpoint Medical completed a clinical trial in the United States in 242 rheumatoid arthritis patients. And those patients derived significant clinical benefit. Now, some of these patients who are now better because they have a vagus nerve stimulator implanted in their left neck

Some of these patients had already tried three or four different biologic drugs and had no benefit. So that's the first reason I'm so excited and optimistic because I've seen the data. The FDA, as we speak, Jason, the FDA are looking at 18,000 pages of data to make a decision on regulatory approval in the U.S. But the second reason is because I've met patients who were in those trials.

who are now having no symptoms. Their arthritis is gone, as far as they can tell, and they take no medications. Their only medication is the electrons being delivered into their vagus nerve through a computerized device that's about the size of a multivitamin implanted in their left neck. Wow. So...

So RA is essentially an autoimmune condition, which is inflammation. And so pharmaceutical interventions as it relates to RA have very serious side effects. And so this is game-changing for people suffering from RA. I think a multitude of autoimmune conditions...

So if I'm listening, whether I have autoimmune or RA, or maybe I just want to really work on my HRV and our HR, is it just an implant specifically? Or are there other interventions? Like what does it look like for listeners today who are interested in taking a next step and maybe walk us through like the implant, which I think is like the, say the...

the Rolls Royce treatment, if you will, versus like, what's the Toyota?

everyday treatment here or product? You know, as we move into talking about what to do, I think obviously patients should speak to their physicians first, as you and I have talked about it and now, because every treatment has implications for every patient and patients differ from patient to patient and treatments differ from patient to patient. But to start with

The simple things first, it's true. You and me and probably most of your listeners would be very interested in optimizing their health and getting the right amount of sleep, reducing stress in their lives, eating a balanced diet, watching their weight. All of those things have been proven to both

enhance your vagus nerve tone and decrease the amount of inflammation in your body. But as we already talked about, this is very important. If you have patients who are doing this now and they still have either poor vagus nerve tone or inflammation in their body, it's not their fault. These are best practices for a healthy lifestyle, but they don't mean they work in everybody. At some point, if rheumatoid arthritis occurs,

or inflammatory bowel disease, which we should also talk about, or other serious inflammatory conditions, then it's time to add in medications. The current standard of care progresses from, in rheumatoid arthritis anyways, from agents such as methotrexate and steroids, which do have

many side effects up to more powerful agents called biologics, which have to be injected. They can cost up to $100,000 per year. And many of those injections help millions of people. So you can have up to 40% of patients having very good clinical responses to these drugs. But these drugs have black box warnings. They have dangerous side effect profiles because

because they suppress the immune system and immunosuppression leaves patients open to secondary infections, even cancer. So the idea behind using vagus nerve stimulation as a therapy is multiple fold. First, it delivers signals into the vagus nerve to control inflammation, to suppress inflammation. The vagus nerve evolved

in parallel with the mammalian immune system, over hundreds of millions of years. It's a natural regulatory network. The biologics that are used did not evolve over hundreds of millions of years. They're not part of the natural network that controls inflammation, like the vagus nerve is part of a natural network. And so by tapping into the power of the vagus nerve to stop inflammation, you're actually doing it in a way that's not immunosuppressive.

So when you look at what happens to the cytokine level specifically, they don't go to zero when you use vagus nerve stimulation. So patients are not immunosuppressed. In fact, some 200,000 or more patients have received vagus nerve stimulation therapy for treating epilepsy dating back to 1997. And immunosuppression is not a dangerous side effect in these patients.

So, it comes back to what you asked me earlier. Why did I make that statement and why am I so optimistic? Because I've seen the data, I know how it works, I know that this can be done safely in human beings.

And I've met patients who benefited from this, and it's pretty amazing to meet a woman who couldn't button her blouse, lost her job as a teacher, grammar school teacher, moved from New Jersey to Hawaii, getting treatment for her rheumatoid arthritis from New York to the Mayo Clinic to Hawaii and back, and all over a period of many, many, many years with no effective therapy.

And now to see her taking no medications and having no signs or symptoms of her illness. I mean, that's what it's all about, Jason. That's why we do what we do. And I think it's time for millions more people to have the opportunity for this kind of therapy.

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It's remarkable. And in terms of the implant, can you walk, like, what does that procedure look like? The procedure to have a vagus nerve stimulator implanted of the kind that Setpoint developed is an outpatient procedure. So like any other outpatient procedure, you'd come in in advance and probably have some sort of presurgical testing, get cleared for surgery. On the day of surgery, you come into the hospital or the clinic first.

for a procedure that lasts somewhere about an hour. It's probably going to be done by a neurosurgeon. The neurosurgeon would implant this chip

As I said, it's about the size of a multivitamin into the left neck through an incision that's about an inch or inch and a half long. The device sits on the vagus nerve, which it runs at about the level of your Adam's apple, and it runs next to the carotid artery, the pulse that you feel in your neck.

In this device, there's a battery. There's a computer chip. There is an antenna to communicate with the doctor's tablet. And there is a lead or electronic connection that sits directly on the vagus nerve. But it's all self-contained in a little silastic. It looks like a pee pod that wraps around a pee around the nerve. And that means patients go home the same afternoon, the same day, and they're

Then return to the doctor's office to have the device switched on via the doctor's tablet. Fascinating. So if I'm, call it an everyday optimizer where I'm not suffering from RA and I probably don't want to go through an implant procedure, but I would love to lower my resting heart rate or increase my HRV and I've done everything. And if I can get a 10%, 20% bump, I'm going to try it.

Is there something for me? Today, no. Well, I applaud your efforts at trying to enhance your vagal tone and to keep your heart rate low. I do the same thing. I try to do as best I can all the things that we're talking about, diet, exercise, sleep.

And, but interestingly, there's a lot of people exploring other avenues to stimulate their vagus nerve. But let's, before we get to that, let's just make one more point. The reason, there should be plenty of reason to want to increase vagus tone because if not for the simple one I said before, that people with slower heart rates as a population tend to live longer and have longer health spans. But you're asking the question of,

Is there a way for a chip or should people at risk of heart attacks, maybe a high family heart attack risk history or a risk of Alzheimer's because of a family history or a genetic predisposition or a risk, even risk of cancer. Some cancers are highly associated with the predisposition are caused by inflammation. What about should for it will someday will someday 45 year olds.

50-year-olds have implants for one way or another to stimulate their vagus nerve to reduce their inflammation while they live their normal lives? Jason, I think maybe. Are we there yet today? Absolutely not. Where we are today is best possible.

health practices that we could dive into a little more. Yeah, let's do that. And one of them which caught my eye in the book, you talk about the ear-brain-body connection. I've heard brain-body, but not ear-brain-body. So let's talk about the ear here. So the ear is an interesting thing in this story, Jason. So it turns out that there is a branch of the vagus nerve that goes to the cartilage of the external ear.

So if you put your finger in your ear, you will feel cartilage around that part of the ear. And if you look in the mirror or look at a picture of an ear, it looks like a seashell. And so that part of the ear is called the simboconcha. And that part of the ear is innervated by a sensory branch of the vagus nerve.

Now, that means that if you stimulate with your finger or with a TENS unit, an electrical, you know, transcutaneous electrical nerve stimulating unit that you can buy on Amazon or anywhere for not a lot of money. If you stimulate that part of the ear, the signals travel in the sensory vagus nerve, which means it carries the signals into the brainstem.

Now, that's not the only nerve in your ear. There's several other nerves that innervate the external ear, but there's been many, many, many, too many to count, clinical studies and publications in peer-reviewed journals that

that electrically stimulating the simbaconcha of the ear has health benefits in a variety of conditions associated with inflammation. So essentially it's a vibration of the ear to some degree, if I'm understanding correctly. There's a few ways of doing it. One way is to use a mechanical vibrating device. You have to be careful with those. I'm not recommending any treatment to your listeners. Of course, they should check with their doctor, but if

A vibrating device will stimulate the neurons in the simpacotia associated with the vagus nerve. The danger of a vibrating device is that you can damage the middle ear or damage your earring if you vibrate too much. You can do it with a TENS unit, which there are FDA-approved TENS units that you can buy over the counter. And these TENS units, they send electrical pulses, not vibrations, but electrical pulses into the ear.

So, you know, a typical setting for this would be

on the order of like 200 microsecond pulse width, 30 hertz pulse rate, and you would turn up the amperage or the strength of the signal until you feel something. You shouldn't feel pain, but you might feel a tingling in the ear. Now, those kinds of studies, and some of the studies are very high quality, well-controlled studies,

Some of the studies are not high quality and not well controlled and are quite questionable. But on balance, there is significant interest in seeing a reduction in inflammation in some of these studies ranging from inflammatory bowel disease. My colleague here at Northwell at Cone Children's Hospital, Ben Son, reported a study where he looked at children with pediatric Crohn's disease.

and had a very significant impact on not all of them, but on many of those patients who did much better. We've published on rheumatoid arthritis with this approach. We've published on treating patients with arthritis associated with lupus, with systemic lupus erythematosus.

And then there's many studies looking at anxiety disorders and other conditions. So it's an important area that we don't completely understand. Here's what we know. What we know is that some well-controlled clinical trials are highly suggestive of some beneficial effect. And we know that there's a branch of the vagus nerve to the cartilage of the ear.

And we know that if we electrically stimulate or mechanically stimulate that branch, that that can produce some of these effects. But we don't know how it works because once the signals get into the brain, now you're interacting with tens, if not hundred billion neurons with 10,000 connections per neuron. So we don't know exactly where those signals go or how they come out to the body. And we don't know how an individual brain

patient or subject would respond to a specific treatment because that individual patient may have a slightly different wiring of their nervous system, or they could have had injury to those nerves in the ear. So there's so many variables that we don't know yet that is still an area of active study by many, many, many centers. It's just so interesting because we've never really, or at least personally, I can say I've never really thought about

ear health you know i we we've thought about the nose and nasal breathing but it's really one to follow as we think about like our ear that's it makes the case you know my one personal side note i made the mistake once of going a little too deep at a q-tip and all of a sudden i started to feel like a cloud on my ear and then boom i had vertigo for the first time in my life

and it scared the hell out of me for like an hour and a half two i was like whoa i started to do some you know i went to doctor google after of course and i said to myself i'm such an idiot but the memo for me was wow there's more to the ear here as it relates to our well-being that i'm aware of and this idea of you know vibration frequency around the ear

is one to follow. It's very low lit. Like if you say to someone, you gotta go to the gym, you gotta run yourself silly, work on your VO2 max,

Okay. I may do that. I may not. But if we're talking about like a gentle ear massage here, a lot of people are going to raise their hands. It's a fascinating topic. And as I said, some of the clinical results point to the importance of figuring it out. But a lot of people, many of us are still in the process of trying to figure it out. I mean, my grandfather was a professor of pediatrics at

at Yale and New Haven. And when I was a little boy, I remember the advice he gave me, which I should pass on to you now from your story, which is never put anything in your ear larger than the elbow of your opposite arm. Ha, ha, ha, ha, ha.

I love that. But you talk about Crohn's and the ear. Like Crohn's, I have friends who have Crohn's. That's a tough setting in terms of living your life. And the last thing I would think about is my ear. So it's true. It's not what most people think about. I mean, if students and practitioners of acupuncture know all about the ear, and as you know from that chapter that you read, there are famous...

acupuncture methods that use needles inserted into specific points along the ear, which map to specific organs in the body. And this, you know, if you talk sort of casually to people who know about acupuncture in a casual way, everybody knows that these acupuncture points are ancient and they date back thousands and thousands of years. But that's actually not really true. Actually, a

a French physician in the 1950s was treating patients in his regular practice and noticed a few patients had come in with scars on their ear that were caused by cautery from a different practitioner who was burning off a little piece of the patient's ear to treat their sciatica. Yes, it's a true story. But what Dr. Nogier noted was that

These patients actually did derive benefit from their sciatica. So Dr. Nagy took a ballpoint pen and he removed the ink and he used it as a probe on his patients in his practice. And he probed pushing different pressure points on the ears of his patients and recorded what the patients reported. And he did this for many, many years. And he ultimately developed a map that he called auriculotherapy.

of acupuncture or acupressure points on the ear, which he presented to the Chinese acupuncture societies in China and they published it for him. The actual quote unquote ancient Chinese acupuncture maps were developed in France by a Frenchman in the 1950s. What's fascinating about this is that some of these points on these maps are in the Simba concha and you can make theories

that vagus nerve fibers are innovating some of these points that he and subsequently many others have assigned to specific organs like the spleen. Now, the spleen, we know, is a target of vagus nerve stimulation therapy. It's a source of cytokines and white blood cells that drive inflammation in many conditions. And I will tell you that the spleen does not have sensory nerves. So it's

It's very hard to imagine how anyone could have figured out a point on the ear that maps to the spleen, but it happens to be in the simboconcha. So there's a lot of interesting connections here. For sure. Something else in terms of lifestyle, which I'm a big proponent of and I enjoy doing daily, cold plunge. Can you talk about cold plunges? Yes. And again, that could be the topic of another entire hour discussion. So

And it's really important because...

Let's just cover this for a second, Jason, because there's billions of web impressions on Vegas Nerve. There's I don't know how many on cold plunges. I don't know how many on deep breathing and meditation. But the problem is there are grains of truth to many of these things that you can find either on social media or on the web about these various modalities, including cold plunges.

And the grain of truth is important. And some of these grains of truth are rooted in deep science. But some of the recommendations and some of the interpretations of these grains of truth

It stretched the truth and may or may not be true or may not be known. So in cold plunges, I like to break down the explanation into two parts. The first thing that happens if you do a true cold plunge, which would be jumping in cold water or turning the cold shower, the shower onto full cold, even after a hot shower, that that first response to significant cold is fight or flight.

There's a massive surge of adrenaline of norepinephrine and epinephrine in your body, which of course causes your heart to race.

And it's that feeling, if you've ever jumped in a cold lake or a cold ocean, it's that feeling where every molecule of air is forced out of your body and you can't breathe and it hurts. And that fight or flight, it turns out in this sort of extraordinary amount, that's anti-inflammatory. That turns off inflammation.

It's counterintuitive to what people think about in terms of anxiety, which is this chronic fight or flight. Chronic fight or flight, I would describe as anxiety.

low-level, ongoing, persistent fight or flight or stress responses, that's pro-inflammatory. That turns on inflammation. But the massive fight or flight you get from running a 100-yard dash, from racing up a mountain, or from jumping in freezing cold water, that's anti-inflammatory. So that's happening. Now, if you can will yourself to stay in the cold,

And the human physiology studies that have done this are fascinating. I mean, putting volunteers in freezers, in wet clothes with a fan on them, or studying soldiers who march around.

in short pants across, you know, the frozen tundra and on and on and on. What's quite clear from those studies is that cold adapted responses slow your heart rate. It takes a while though. You know, the cold plunge in and out, that's fight or flight fast heart rate.

decreased inflammation. But if you stay in the cold, and here I advise doing that in a way either with a friend or colleague and not in water where you can drown, because that's happened too. But if you can stay in the cold for a period of minutes, probably five or 10, now your heart rate slows. And that's your vagus nerve effect or your parasympathetic effect. And

That's why I do it. I'm with you. I do it every day for three minutes. And you notice it, right? You get in, it hurts. It's like, what am I doing? And then you stay there and you feel everything slow down. You feel the heart slow down. You feel your body slow down. Yeah. It's been an acquired taste. I live in Miami. I hate the cold. I don't ski. I don't miss New York. Not

I love being in warm weather. So never really liked the cold, so I was resistant to it for quite some time. But I picked it up in the last year and love it. And I'm also very interested in 50 and want to optimize my testosterone.

There's some interesting findings as it relates to men and testosterone and cold plunges. The science isn't fully there, so to speak, but I'm currently doing my own out of one to see what happens. But I love it. Clear head.

really get to control my breathing. I feel like I've missed something if I don't do it daily. I'm fascinated by the experience because, you know, like you, it took me a long time to build up to having any sort of tolerance for it. But, you know, small increments, if anyone wants to do this for the first time, you don't have to start with the water on full cold. You don't have to stay in for an hour. Small increments gradually lengthen the time, make the water colder. But despite the fact that

I've been doing it for quite a while. Every time, it's awful for the first few seconds. It's absolutely awful. But then you find yourself, it's like, yes, it's awful, but I don't mind it. It's as if I'm watching somebody else have the experience, even though I'm aware that it's awful. It's really interesting.

Yeah, I've grown to love it. It's hot. I don't even experience the awful anymore. And I'm not a masochist as it relates to exercise at all. I don't run. I don't like running. If you find me running, it means I'm being chased. Call the police. I'm in trouble. So in terms of the future, what do you think we're going to be looking at in the next three to five years as it relates to the vagus nerve and vagus nerve therapy? Where

Where are we going? Where would you like it to go? I think it's quite likely that within the coming year or two, you're going to start to see devices available for stimulating the vagus nerve that will be used probably in the first patients, in patients who've already had multiple other medications and still are not being used.

adequately treated, probably in rheumatoid arthritis. I think we already know that the FDA has approved various methods of vagus nerve stimulation to treat epilepsy, to treat depression, to treat withdrawal from opioids, and to enhance the effectiveness of physical therapy in patients who've had strokes affecting their hands and arms. So there's a path

for this to be done safely. And I think patients faced with

crippling or serious inflammatory conditions are going to seek this out. I think there will be a barrier to adoption. I think it's going to take time for practitioners, doctors, nurses, clinics, insurance payers for the whole system to accommodate this new idea, which you said surprised you. It's going to surprise a lot of people. But I think what has surprised me is how well it seems to work in some people.

I think you're going to find patients, maybe half of them who have this therapy have a really, really big benefit and another quarter. So 75% have a smaller benefit. And I think a small percentage will have no benefit either because their disease is a

We don't completely understand their disease or we don't completely understand how to use this new therapy yet. However, I think we'll find that it's safe. And I think you're going to find that patients prefer this to injecting themselves

with drugs that have black box warnings that cost $100,000 a year and only work half the time. 100%. And I could say I'm optimistic on the FDA. We've had Marty Makery, the new incoming commissioner of the FDA on this podcast. And judging from my conversation with him, I think he's going to be very receptive to what you're working on. It could really impact a lot of people's lives. Kevin, we touched on a lot.

other than picking up the book, which I highly recommend. Anything else you want to touch on before we close? I think, you know, you asked about the book and the title of The Great Nerve. And, you know, and I told you Galen,

The original physician 2,000 years ago named it the great nerve. And if you look online, if you look anywhere, everyone knows the vagus nerve is the wandering nerve, as in vagabond or vagaries. And that name actually came in the 16th century or so when anatomists decided to rename the great nerve the vagabond.

the vagus nerve, because they saw it wandering all over the body. Well, I think Galen's name is better because the vagus nerve to me isn't wandering anywhere. It knows exactly where it's going. It knows exactly what it's doing. And what it's doing is keeping us all healthy. So I think the great nerve is a better word. Also, Kevin, thank you so much. Thank you for having me, Jason.