Vagus Nerve

101 Stimulation Exercises That Change Life - How to

Naturally Activate Your Vagus Nerve for Unlocking
Creativity, Preventing Heart Disease, Overcoming
Dyslexia, Anxiety and Depression

Jason Dyer
 Contents
INTRODUCTION
CHAPTER 1
WHAT IS THE VAGUS NERVE?
CHAPTER 2
WHERE IS THE VAGUS NERVE LOCATED?
INTO THE NECK
INTO THORAX
INTO THE ABDOMEN
CHAPTER 3
THE FUNCTIONS OF THE VAGUS NERVE
SENSING SKIN OF THE EAR
ALLOW YOUR FOOD TO BE SWALLOWED
MANAGING YOUR AIRWAY AND VOCAL CHORDS
MANAGING THE RELEASE OF DIGESTIVE ENZYMES FROM THE
PANCREAS
MANAGING GUT MOTOR FUNCTION
MANAGING THE OPERATION OF THE IMMUNE SYSTEM
MANAGING INFLAMMATION IN THE GUT
RELAYING KNOWLEDGE FROM THE MICROBIOME
ALLOWING US TO BUILD MEMORIES
CHAPTER 4
HOW THE VAGUS NERVE MANAGES IT ALL
RELEASING THE CHEMICAL MESSENGER
PART 2
ACTIVATING YOUR VAGUS NERVE
CHAPTER 5
MEASURING VAGUS NERVE FUNCTION
HEART RATE VARIABILITY
 RESTING HEART RATE AND HEART RATE RECOVERY
PARADOXICAL BREATHING PATTERN CHECK
SESAME SEED BOWEL TRANSIT TIME TEST
CHAPTER 6
EXERCISES TO ACTIVATE THE VAGUS NERVE
BREATHING HABITS DURING SLEEP
GETTING GOOD SLEEP
ACTIVATING GAG REFLEX
YOGA AND PILATES
MINDFULNESS PRACTICE
THERAPY
LAUGHTER AND SOCIAL CONNECTEDNESS
LISTENING TO MUSIC
WISE DIETARY CHOICES
DAILY MOVEMENT AND EXERCISE
SUNLIGHT EXPOSURE
SUPPLEMENTATION
PROBIOTICS
OMEGA-3 FATTY ACIDS
5-HTP FOR SEROTONIN
COFFEE ENEMAS

CHAPTER 7
PASSIVE METHODS TO ACTIVATE THE VAGUS NERVE
AURICULAR ACUPUNCTURE
MASSAGE THERAPY AND REFLEXOLOGY
VISCERAL MANIPULATION
CHIROPRACTIC TREATMENT
ELECTRICAL STIMULATION
PART 3
CHAPTER 8
WHAT COULD GO WRONG
DYSFUNCTIONAL BREATHING
DYSFUNCTIONAL AIRWAYS
MONOTONE VOICE
DYSFUNCTIONAL HEART RATE
CHRONIC STRESS
INABILITY TO HANDLE STRESSFUL SITUATIONS
LACK OF SOCIAL CONTACT
 INTRODUCTION

Your heart will beat 100,000 times today without your giving it a second
thought. You will be taking 23,000 breaths. Three times a minute, your blood
will flow through your body, and your liver must continuously cleanse and
detoxify the blood. The ever-changing bacteria species in your gut will work
symbiotically with your digestive tract to break down your food and consume
the nutrients that each of your cells requires to survive. Did you ever wonder
how this happens when there is no conscious control? How do all those
processes work together?
The key to this is the autonomous nervous system. The device is a wonder of
evolution. This is the portion of the nervous system that regulates
unconsciously guided bodily functions.
Our bodies are built to live and function without having to think consciously.
As humans evolved, we increasingly increased our capacity for critical
thinking. It was only possible as the mechanisms needed for survival were
subconsciously or, ultimately, automatically controlled. The forebrains have
evolved and let us think, ponder, and interact with the world. Meanwhile, our
brainstem has kept us alive and healthy.
The brain-stem is the spinal cord's thickest and highest level. There are
several information control centers within the brainstem, called nuclei, each
with a different set of functions from which it manages and sends or receives
signals.
These mechanisms alert us to both internal and environmental stressors and
threats to our survival. If such stressors are triggered by an illness that
develops in our bodies, anxious thoughts about tasks that need to be done, or
the physical appearance of a tiger in front of us, this system's automatically
controlled functions enable us to survive. These functions are regulated by a
branch of the autonomic nervous system called the sympathetic branch (or,
for convenience, sympathetic nervous system). It is understood that the
sympathetic nervous system raises the heart rate, raises the pulse rate, reduces
pulse volume, shunts blood flow to muscles in the arms and legs and away
from the liver and digestive tract, and dilates our eye pupils. This method
helps us to counter stressors or "take flight" and run away from the presenting
stressors. It is called the "fight-or-flight" condition when the sympathetic
nervous system is involved.
There is, by comparison, another branch of the autonomic nervous system
that helps us to relax and recover from the day's rigor and tasks. It helps us to
remain calm, lower our heart rate, lower our breath rate to take deeper, fuller
breaths, and shunt blood flow away from the limbs and into the internal
organs, which enables our bodies to heal, stay calm and even procreate. This
branch of the autonomic nervous system is called the parasympathetic branch
(the parasympathetic nervous system, to be exact). It is called the "rest-and-
digest" condition when the parasympathetic nervous system is involved.
The vast majority of controls claimed by the parasympathetic nervous system
pass through a particular nerve pair in the body-the vagus nerve, which is the
subject of this book. It is the only nerve with its roots in the brainstem and
passes through the entire body. The vagus nerve (actually the vagus nerves,
because there are two paired structures, with one on either side of the body)
controls movement of the heart, lungs, throat and airway muscles, liver,
stomach, pancreas, gallbladder, spleen, kidneys, small intestine, and part of
the large intestine. How well the functions of the vagus nerve are a good
determinant of health; vagus nerve dysfunction is strongly associated with
illness.

Earlier, we assumed that nerves had a simple job: to relay signals rapidly
from one place to another. We now find that the messages and signals
transmitted by the vagus nerve is much broader and more significant than we
knew initially; in addition, it is the direct connection between the brain and
the gut microbiome. The vagus nerve is the most critical means of
communication pathway regarding food, nutritional status, and the ever-
changing population of bacteria, viruses, yeast, parasites, and worms living
within our digestive tracts.
Harmony between the two branches of the autonomous nervous system is
important in order to live life. Overactivation of one branch and disregarding
the opposing branch may cause severe loss of function. Chronic disorder
sends us later of instability and disease. The parasympathetic system loses the
ability to function if the stress levels remain too high for too long. Blood flow
and function are based on the sympathetic branch, meaning blood flow to the
parasympathetic branch will be restricted, and thus function will be
decreased. The reverse is also true, as parasympathetic system overactivation
will hinder your ability to cope with possible stressors and build risks for
your survival.
It is a very common problem today: that we are living under enormous stress
levels and placing massive amounts of pressure on ourselves. The capacity of
our bodies to differentiate between types of stressors has not yet developed,
and mental and emotional stressors evoke the same reaction as the
appearance of a lion, tiger, or bear –anything that threatens our existence.
This means we will respond identically to the imminent physical danger, just
like we’d respond to our high school teacher shouting "pop quiz," or our
supervisor sternly exclaiming she wants to see you "immediately" in her
office. Our bodies generate high levels of inflammation under consistent
stress rates and are not given the opportunity to heal and relax, which is
necessary to maintain optimal function. For this cause, we break down much
faster and more frequently than we used to. We are developing autoimmune
disorders such as rheumatoid arthritis, thyroiditis of Hashimoto, and higher
levels of multiple sclerosis than our medical system can keep up with. We are
developing all cancers and heart disease and are dealing with alarmingly high
levels of obesity and diabetes, and collectively, our metabolism has never
been worse. Our bodies will fight back and perform the tasks that our cells
performed, helping us to resolve many of those conditions, provided the right
opportunity to heal. The problem is so many of us don't give this opportunity
to our bodies.
We stress ourselves by consuming highly refined foods (which are brought to
us by an agricultural system that is more concerned with high yields and
convenience than nutritional value) while spending more time indoors, away
from nature, and worrying about loved ones while failing to care about
oneself. Meanwhile, we want our physicians and healthcare professionals to
keep up with our life's demanding rate of transition.
There is a solution to these problems: take back your own health obligation.
Instead of depending on your physicians to monitor your wellbeing, take
power back, and use them as a tool to test your own hypotheses. Do your own
study, learn how to handle your own stressors, and discover what causes are
bringing you into a stressed state. Your primary care doctors are a very
valuable tool, but you're eventually setting yourself up for failure when you
turn over responsibility to a program low of money and oversees hundreds
and thousands of patients.
I will be inspiring you to take back control of your health in this book. I'll
help you discover the root factors ignored by many negative health problems
that your doctor does not yet know are the true reasons your health is so bad.
Your doctor would probably not even know there are practical laboratory
tests to help you discover those blind spots. I will give you practical daily,
weekly, and monthly tools you can use to improve the function of your vagus
nerve and parasympathetic nervous system so you can better recover from the
stressors of each day.

HOW THIS BOOK IS ORGANIZED

This book is organized into three parts.
Part 1 will concentrate on medicine, primarily the anatomy, neuroanatomy,
biochemistry, and vagus nerve basic functions and the processes it regulates.
If you are more of an action-taker, you can skip through this segment. To get
a better understanding of this nerve and its behavior, this section is important
to read about.
Part 2 will concentrate on feature improvement and optimization. I will
discuss common techniques and procedures used by industry experts,
colleagues, and my patients to improve this nerve's work to recover and
resolve the root causes of their health conditions.
Part 3 will concentrate on vagus nerve dysfunction" its signs, symptoms, and
root causes, and how to measure this nerve's activity with the tools you will
use every day. It will be a valuable chapter for many people who suffer from
different health issues and want to dig deeper to decide why the problems can
arise first.
If you're prepared to take control back and put your safety in your own hands,
then buckle up. Let's get at it, right!
 CHAPTER 1

WHAT IS THE VAGUS NERVE?

If the human brain were so simple we could understand it, we would be
so simple we couldn’t.
—Emerson W. Pugh
This stumped anatomists. How can a single nerve that begins in the
brainstem be so long and interact with so many organs? What
consequences could probably this nerve have? What would happen if
the nerve is damaged or cut, considering its large array of possible
functions?

WHAT IS THE FUNCTION OF THE VAGUS NERVE?

The vagus nerve (VN) originates in the brainstem --essentially the brain
trunk, which detects, processes, and regulates the vast majority of the
body's automatic functions. Mostly, to make them happen, we do not
have to actively think about certain roles. Those are called autonomic
functions and are governed by the autonomic nervous system.

WHY DO WE CALL IT THE VAGUS NERVE?

Vagus is derived from a Latin word meaning " wandering, rambling,
strolling," often and to a lesser degree, "uncertain or vague." On initial
analysis, the anatomists and researchers needed a descriptive term
meaning this. When they landed on the word vagus, they literally called
this nerve "the wanderer." Some functions controlled by the autonomous
nervous system included:
Beating of the heart
Blinking of eyelids
Breath rate and depth
Constriction and dilation of blood vessels
 Detoxification in the liver and kidneys
Digestion in the digestive tract
Opening and closing sweat glands
Producing saliva and tears
Pupil dilation and constriction in eyes
Sexual arousal
Urination

Neurons here receive input from other cells all over the body. Such
nuclei have different functions and are distinguished by names derived
from Latin. Nuclei are like a router being linked to a home internet
network. Some information enters the router through your cable link or
telephone line, the information is processed in the router, and other
information is then sent out from the router to your device, television,
and any other devices linked to your network.
There are two main neurons, and in one of two directions, they send
information. The first is afferent neurons that collect information about
what's happening inside and around the body. Afferent neurons take
input toward the brain from the body, called afferent information. The
second is called efferent neurons, which send information to different
organs and structures in the body with regulatory or motor effects
(called efferent information) so efferent information is transmitted from
the brain to the body.
The vagus nerve is attached inside the brainstem to four separate nuclei.
Eighty percent of the information that the VN transmits is afferent
information, indicating that the most common way that information
travels in the VN is from the body's organs to the brain. The remaining
20 percent of VN neurons provide an efferent signal, spreading from the
brain to the body, contributing to different roles in each cell and organ.
It's interesting to hear that most medical students are surprised by the
fact that only 20 percent of the VN's work is efferent, as it has so many
efferent effects on the organs –just imagine then the amount of
information that this nerve relays back to the brain, more than four times
as much as the information it relays away from it.
Unlike the wires of your home network link, the neuron bundles inside
your nerves transfer information along their length using electrical
signals that contribute to the release of a chemical signal called a
neurotransmitter after hitting the end of the nerve. These
neurotransmitters bind to receptors on the receiving cells, resulting in
the cells at the end of the connection having an impact. The main
neurotransmitter used by the VN is called acetylcholine (in short, ACh),
which has a strong anti-inflammatory effect in the body.
Managing the inflammatory system is one of the VN's most critical
functions; it is the body's primary inflammatory control mechanism and
has far-reaching effects on your personal health and illness. Many of my
patients ' health problems are due to elevated rates of inflammation in
many organs and systems, from the digestive tract to the liver and even
the brain.
Inflammation is a major reaction inside the body to keep us healthy from
bacterial and viral pathogens, physical damage, and other things that do not
reach the body optimally. The results can be wide-ranging and contribute to
several different health problems when inflammation rates are not held in
control and become chronic. Several specific disorders linked to elevated
rates of inflammation include:
Arthritis
Alzheimer’s disease
Asthma
Cancer
Crohn’s disease
Diabetes
Heart and cardiovascular disease
High blood pressure
High cholesterol
 Postural orthostatic tachycardia syndrome (POTS)
Ulcerative colitis
As well as any condition that ends in the suffix “itis

Majority of the organs that are at risk in these conditions are connected by the
Vagus nerve. Thus, it is impossible but mostly likely that the vagus nerve is
functioning suboptimally and not having its anti-inflammatory consequence
on these organs, leading to chronic inflammation and/or disease.
It is important to note that these conditions will not exist in isolation,
and if there is one of these conditions, it is probable that there will be
another. The same signals are transmitted to and from almost every
internal organ through the vagus nerve, and if inflammation rates are not
regulated in one organ, the same is likely to occur in other areas.
 CHAPTER 2

WHERE IS THE VAGUS NERVE LOCATED?

The longest nerve in the body is the vagus nerve. Without being too
technical, I would like to illustrate where the nerve begins and how it flows
and enters the organs it innervates and sends information from and to. Let's
follow through the body along its course.
BRAINSTEM CONNECTIONS
The neurons that make up the vagus nerve begin in the brainstem, originating
from four nuclei. Such nuclei are formed by the dorsal motor nucleus, the
solitary nucleus, the spinal trigeminal nucleus, and the uncertain nucleus.
Growing of these nuclei regulates nerve fibers unique to their components.
Sensory neurons transports signals from the skin which the VN innervates to
the spinal trigeminal nucleus. It involves a particular portion of the ear's skin,
which is necessary when using acupuncture treatment to stimulate the vagus
nerve and will be addressed in later chapters. Signals from the body's internal
organs are carried through the vagus nerve to the solitary nucleus and passed
up into the brain for further processing. Such signs include stomach,
intestine, lungs, pulse, liver, gallbladder, pancreas, and spleen. We can also
send direct signals through the vagus nerve to these organs using
parasympathetic fibers which originate in the dorsal motor nucleus. Such
signals help to relax and control the heart and lungs activity, and increase the
gut and intestinal tract, liver, pancreas, gallbladder, and spleen action.
The nucleus ambiguus is the final nucleus which contributes fibers to the VN.
This nucleus sends out motor functioning neurons, primarily working to
regulate most muscles present in the throat and upper airways. These muscles
are responsible for holding the airway open and transmitting sound through
the vocal cords, thus generating your voice.
The right and left vagus are the only nerves in the body that have four
different functions and four distinct nuclei contributing directly to component
fibres. Most other body nerves bring basic sensory input to the muscles from
the skin and motor signals. This simple distinction will make you aware of
the true importance of the vagus nerve and the broad scope of its operation.
Now, let's trace the nerve path down through the neck, thorax (chest area),
and abdomen (belly area) from the brainstem.

INTO THE NECK

The fibers of the left and right vagus nerves reach into the cranial cavity (the
inside of the skull) from the brainstem region known as the medulla
oblongata and converge to form what we call the vagus nerve. Then the nerve
passes into an opening called the jugular foramen from the skull. This
opening is a large gap for movement between the neck and the skull between
the nerve and other blood vessels. If the VN leaves the brain, it joins the
upper neck region right behind the jaw, between the inner jugular vein and
the carotid artery inside. Such blood vessels are the main blood lines to and
from the brain and are very necessary to keep us alive.
Being so close to these different blood vessels is an indicator of how vital the
vagus nerve is because physical trauma can cause irreparable trauma to any
of these three structures. In the case of blood vessels, damage will lead
directly to death, while nerve damage can result in a total loss of function in
many of the body's organs.
There is a thickening of the nerve called the superior ganglion (or jugular
ganglion) shortly after the vagus passes through the jugular foramen. A
ganglion is a nerve thickening produced by a group of sensory neuron cell
bodies very close to each other. In this ganglion, the cell bodies of the
sensory nerves congregate and then develop into the thinner nerve segment,
resulting in the vagus nerve's first branch.
The VN's first branch is referred to as the auricular branch. The auricular
branch passes through an opening called the mastoid canaliculus back into
the skull, and through another skull hole called the tympanomastoid fissure
back into the head.
The nerve stretches to each ear's tissue. This branch senses pressure,
temperature, and wetness on the ear skin; in particular, the outer canal, tragus,
and auricle. This is the key focus for VN dysfunction activation therapy using
auricular acupuncture (acupuncture points in the ear), which we will explore
in later chapters.
As the nerve continues to move down (or inferiorly, using anatomical
language) from the upper ganglion, the VN thickens again to form the lower
ganglion, also known as the nodose ganglion. This ganglion houses the
neuronal cell bodies involved in taking in input from the internal organs. The
nerve then thins out again and enters a passageway formed by a thickening of
the connective tissue called the carotid sheath immediately. As it passes
through the heart, the vagus nerve, along with the internal carotid artery and
the internal jugular vein, is given extra soft tissue protection.
The vagus nerve gives off their next branch inside the carotid sheath: the
pharyngeal branch. The pharyngeal branch has vagus nerve neurons but also
bears some contributing neurons (glossopharyngeal and peripheral nerves)
from the ninth and eleventh cranial nerves. As these neurons merge, they
move over to the body's midline before they enter the upper portion of the
mouth, called the pharynx. The vagus nerve in the pharynx relays motor
impulses to various muscles involved in the swallowing reflex, controls the
opening and closing of the upper airway, and retains the gag reflex.
It gives rise to the third branch, known as the superior laryngeal nerve, while
the vagus nerve descends the sides of the neck within the carotid sheath. This
nerve branches off the VN very soon after the pharyngeal branch, and
supplies motor signaling to the larynx muscles above the vocal cords,
specifically the muscles that regulate your voice's pitch.
As the VN runs down through the carotid sheath, it gives rise to the branches
of the cervical cardiac, which are two of the three branches that innervate the
heart. Immediately after leaving the carotid sheath in the chest (thorax)
region, the third branch, the thoracic, cardiac branch emerges. These branches
intermingle with the nerves of the sympathetic nervous system and form the
cardiac plexus (a plexus, pluralized as Plexi, is a series of intermingling nerve
fibers of various branches and separate nerves of origin that migrate towards
a particular location). We have two cardiac plexi: one that is called the
superficial cardiac plexus in front of the aorta and one that is called the deep
cardiac plexus behind the aorta's arc. (The aorta is the main blood vessel
transporting blood from the heart to the rest of the body.) Some cardiac plexi
fibers connect to the heart's Sinatrial (SA) node, while some stretch to the AV
node. In the next chapter, we will address the role of those nerves on the
heart. The most important thing to note right now is that these fibers regulate
the electrical activity rate that pumps your heart.
INTO THORAX
After the nerve leaves the bottom of the sheath, it runs down into the thorax,
between the first and second ribs, and before the wider blood vessels
extending from the neck.
The left vagus nerve crosses the aorta's arch before (anterior to) and then
sends off its fourth branch —the recurrent laryngeal nerve. The right vagus
nerve takes a similar path on the opposite side of the body; however, it
crosses in front of the right subclavian artery and then sends off its fourth
branch, the recurrent laryngeal nerve on the right side.
Both recurrent nerves of the laryngeal follow a similar direction, but on
opposite sides. These are the nerve's only branches that are turning and
heading upward again towards the arm. Based on tensioning and loosening of
the vocal cords, they bring motor signals from the brainstem to each of the
larynx muscles below the vocal cords, which are essential for vocal sound
production. We're going to talk more on how we can use such particular
branches to help strengthen the vagus nerve if it functions suboptimally.
When the nerves enter the aorta level, each of the vagus nerves sends
branches off to the next pair of organs, the lungs. The left vagus nerve sends
a pulmonary branch to the anterior pulmonary plexus, and a pulmonary
branch is sent to the posterior pulmonary plexus by the right vagus nerve.
Both branches of the nerves combine with sympathetic neurons, reorganize,
and then move to either side to innerve the lungs. Such branches go to the
bronchi and wider branches of the lungs to open and close them on the basis
of each condition according to the body's needs.
One organ in the thorax which is frequently extremely neglected or ignored
that the vagus nerve innervates is the thymus. The thymus is an immune
system's extremely critical organ. It is found in the chest's mediastinum, just
before the heart but behind the sternum. A vagus branch makes its way to the
nerve to send out signals to and from the thymus. The thymus is the primary
source of training for and growth of our white blood cells early in our
development. The reason this organ is so easily forgotten is that it shrinks
over time and is replaced with fat tissue. This cycle begins during puberty,
and can continue on into early adulthood for several years. I tend to think of
thymus as a school for new immune cells, and as the school gets older and
deteriorates, the consistency of the training that the white blood cells go
through declines.

INTO THE ABDOMEN

The organs of the abdomen are the final segment which the vagus nerve
innervates. Such organs are vital for digestion, for regulating the immune
system, and for ensuring that the blood that enters the rest of our cells does
not contain toxins that can adversely affect cell health.
The vagus nerve's first abdominal branch goes out into the stomach. Once our
body is in the rest-and-digest stage, the vagus nerve fibers activate the
activity of the stomach muscles. They give signals to the parietal cells to
produce and secrete hydrochloric acid (HCI), the chief cells to produce and
secrete the pepsin and gastrin digestive enzymes, and the smooth stomach
muscle cells to physically churn and transfer the food in our stomach into the
next digestive tract, the small intestine.
If the vagus nerve is weakened and these essential signals are not transmitted
to the stomach cells, it can lead to complications like hypochlorhydria, or low
stomach acid, which is a major root cause of many health conditions. To
activate the digestive enzymes and break down food, sufficiently low pH
(high acid) is needed. The maximum stomach pH level will be about 3.0 in
the stomach, while nothing above 5.0 would be high enough to activate
pepsin and gastrin. Low stomach acid allows for a less optimal breakdown of
food. Higher pH in the stomach will also make it possible for unwanted
bacteria, viruses and parasites to penetrate the intestines and create havoc on
the digestive tract.
The second vagus abdominal branch goes into the liver. Interestingly, these
divisions are closely correlated with the feeling of hunger and the need for
other forms of nutrients. Initially, the food we consume goes into the stomach
to be broken down. It then goes into the small intestine, where much of our
macronutrients (protein fats, carbohydrates, and amino acids) are absorbed
into the bloodstream. These nutrients then flow into the liver for filtration,
processing, and sending back to the brain through the portal vein.
Through the liver, the vagus relays information about blood sugar levels, fat
consumption, and overall function of the liver to the brain. The vagus nerve
may also transmit information about the amount of bile needed to assist in the
digestion of fats. The liver has many functions that require vagus input,
including and certainly not limited to the production of bile and bile salts (the
active component of bile), which are then sent to the gallbladder for storage;
the balancing of blood sugar by producing glucose; the management of
hunger and satiety by measuring fat intake; the filtration of blood in the portal
vein that brings all nutrients; For our overall well-being, the liver is very
necessary and the vagus innervation is strongly associated with maintaining
this balance.
The gallbladder is closely linked to the liver. The gallbladder, which is
necessary for our bodies to function optimally, is often ignored by the
medical system,. Once the liver produces bile and bile salts, they are sent for
storage into the gallbladder in preparation for the next meal. The gallbladder
pumps bile into the duodenum (the first component of the small intestine) as
the next meal happens to help get fats into the bloodstream. The gallbladder
pump is regulated by the vagus nerve. The vagus branches out from the liver
to send messages to the gallbladder, activating the smooth muscle cells in its
walls to pump bile into the digestive tract. This occurs in response to a meal
decided by the taste buds (sensory receptors on the tongue) containing fat,
which should be digested until it enters the small intestines.
The next branch of the vagus is directed to the pancreas. Your pancreas is one
of your body's most significant glands, with both an exocrine and endocrine
component. The endocrine pancreas produces and secretes insulin and
glucagon directly into the bloodstream for blood glucose (blood sugar) levels
to regulate. The exocrine pancreas stimulates and secretes digestive enzymes
directly into the small intestine through a channel. The three most notable
digestive enzymes produced by the pancreas are protease, which breaks down
proteins into their amino acid components; lipase, which breaks down fats
into free fatty acids and cholesterol from their components, and amylase,
which breaks down carbohydrates into simpler sugars.
Vagus innervation signals message back into the brainstem from the
pancreas, relaying information about the state of exocrine and endocrine
cells. It also relays information about food intake from the brainstem back to
the liver, and the enzymes are necessary for development and release into the
bloodstream and digestive tract. Vagus innervation is important to transmit
this information, as a lack of signaling can hinder the release of digestive
enzymes, decreasing the efficacy of the digestive process.
As the vagus nerve passes through the stomach, it forms the celiac plexus, a
network formed between sympathetic lumbar nerves and vagus
parasympathetic fibres. This network sends branches into the remaining
abdominal organs.
The spleen is the first organ that is innervated after the celiac plexus. The
spleen is located opposite the liver on the left side of the body, below the left
lung. Its purpose is to track the bloodstream and activate or deactivate
immune system cells based on what they are sensing. Both spleen and thymus
control immune cell function early in our lives, but later in life after the
thymus has vanished, this mechanism is regulated by spleen alone.
The spleen receives signals from the sympathetic branches to activate the
inflammatory pathways that arise in response to or damage from physical and
biochemical traumas. The parasympathetic branches send out signals to stop
cycles of inflammation. The vagus nerve modulates a mechanism called the
anti-inflammatory cholinergic pathway, which has important effects in the
spleen. We will address certain common inflammation-related effects in later.
After the celiac plexus, the next branch of the vagus passes to the small
intestine. Once the chemical and physical churning in the stomach has broken
down food, it joins the small intestine. Here the pancreatic digestive enzymes
and bile undergo more digestive processing. The small intestine has the task
of breaking down and consuming much of our macronutrients. These include
fats, carbohydrates, and proteins (which usually break down into their amino
acid components). The bloodstream receives the macronutrients the small
intestine's lining cells have recognized.
The bite of food we take (which at this point in the digestive process is called
chyme) must be moved along the length of the small intestine winding and
coursing. To this end, the vagus nerve activates the digestive tract's smooth
muscle cells by signaling the extensive network of nerves lining the intestine,
called the enteric nervous system.
Contrary to its name, the small intestine is actually very long, about 22 feet
long, and considerably longer than the larger gut, the next component of the
digestive tract.
We have an incredibly important interaction with the other cells existing
within our digestive tracts. I am talking about the symbiotic relationship
between our human cells and the bacteria that live in our intestines: our
microbiome. The overwhelming majority of our bacterial allies live in the
thicker, shorter region of the digestive tract in our large intestine. While many
essential vitamins, minerals, and biochemical precursors are produced for us
by these bacteria, they can also generate many toxins and methane. We need
a device that can hold these bacteria in our brain's power and transmit signals
about the status of the digestive tract and microbiome work. Therefore, while
the vagus nerve activates smooth muscle cells to push food along the rest of
the digestive tract, the microbiome's main relay path is also to communicate
to the brain. The vagus nerve inwards in the first half of the large intestine–
the ascending and transverse parts.
The final organ that the vagus nerve innervates is actually two organs, with
each one either side of the body: the kidneys. These organs have a variety of
specific roles vital to our wellbeing. In the form of urine, the kidneys pump
fluid out of the body, a mixture of uric acid and water, which is then sent
down to the bladder. Blood pressure is one of the main determinants of this
regulation and will be addressed further in the next chapter. The vagus nerve
is a major controller of kidney activity, and hence has a significant role to
play in controlling blood pressure.
The vagus nerve does not actually stop at the end of its course. Rather, it
forms a final plexus from the lower end of the spinal cord with the
parasympathetic nerves that are. Such parasympathetic fibers innerve the
second half of the large intestine, which is called the descending and sigmoid
colon, as well as the bladder and sex organs.
 CHAPTER 3

THE FUNCTIONS OF THE VAGUS NERVE

An optimally working VN is utterly crucial when it comes to improving
health and halting disease progression. There are many explanations for this,
and in this chapter, we'll go over some of them.
One body that functions optimally is like a symphony orchestra. All the
different instruments have unique parts to play in a symphony, so perfect
harmony can only be accomplished if each instrument is guided toward doing
its job. The orchestra's conductor needs to ensure that no instrument is off
pitch or tempo because a single mistake could lead to disastrous performance.
A conductor that does not keep its end up will also result in a broken
performance.
The vagus nerve is the conductor of a symphony orchestra for the human
body. This controls the activity of so many different organs and cells in our
body, but only when it functions optimally can it do so. The body's multiple
organs and cells must be capable of detecting and communicating correctly.
Dysfunctional signaling can result in a loss of equilibrium in the body, and
ultimately a disorder and disease state.
Let's break down all the various roles that the human body orchestra
conductor performs-the vagus nerve.
SENSING SKIN OF THE EAR
As described in the previous chapter, the first branch of the vagus nerve is the
auricular branch, which is directly involved in the sensation of the skin of the
auricle, the tragus, and the ear's external auditory canal.
This branch's purpose is pure in sensation, enabling us to feel pressure, touch,
temperature, and moisture on each ear's central portion. This is clinically
significant and very critical, as this is one of the main areas where the VN can
be stimulated using techniques such as acupuncture.

ALLOW YOUR FOOD TO BE SWALLOWED

The last thing you're worried about when you're consuming a meal is the
process of swallowing every bite and pausing the breathing reflex so you
don't scare. The vagus nerve copes with this essential function.
The second branch of the VN (the pharyngeal branch) regulates the activation
of five pharynx muscles: the three constrictor muscles at the back of the
throat and two other muscles that link the throat and the soft palate (the soft
tissue at the back of the mouth's roof). These muscles are involved in the
pharyngeal process of swallowing which involves pushing the chewed food
towards the larynx and the esophagus while keeping it out of the trachea, thus
keeping the airways clear of food. The active motor part of the gag reflex is
also regulated by this VN branch.
This is clinically significant because poor vagus nerve function can lead to
coughing and a shift in gag reflex function. This meditation can be used to
help balance the VN with constructive exercises and stimulate the gag reflex.

MANAGING YOUR AIRWAY AND VOCAL CHORDS

Are you conscious of the effort needed to hold your upper airways open for
every breath that you take? The muscles involved in that process are also
involved in your voice development. If you have ever wondered what nerve
is responsible for ensuring verbal contact with others around you is possible,
that's the vagus!
Superior and frequent laryngeal nerves are the third and fourth branches of
the VN. The muscles above the vocal cords are responsible for the dominant
laryngeal branch while the recurrent laryngeal branch is responsible for the
muscles below the cords.\
The superior branch of the laryngeal holds motor information to certain
larynx muscles and regulates vocal pitch. Suboptimal feature of the superior
branch of the laryngeal results in a pitch transition. A chronically hoarse
voice or an easily fatigued, monotonous voice in this branch of the nerve is a
sign of weak vagal tone (signaling capacity). Irritation of this nerve can also
lead to extreme cough and the risk of aspiration (i.e., food or drink entering
the trachea through impaired vocal cord function).
The recurrent laryngeal branch brings motor information to the muscles
below the vocal cords, allowing the vocal cord structures to create sounds by
opening, closing, and tensioning. It also has a sensory component that relays
information of these structures from the esophagus, trachea, and internal
mucous membranes. Dysfunction of these nerves during physical exercise
contributes to heaviness, speech loss, and difficulty breathing.
Those laryngeal muscles control the airway's opening, closing, and working.
Hence, any breathing or speech problems may be due to reduced activity and
tone of the vagus nerve. Airway respiration and muscle tone are of paramount
importance for vagal control. Any persistent obstructions to a clear and well-
functioning airway will impede the function and signaling input from these
muscles, which will affect the vagus nerve function negatively.
BREATHING:
What about breathing? Well, the vagus also has a role to play in managing
this vital function. The VN's pulmonary branch flows through the pulmonary
plexus, binds to the sympathetic nervous system, and innervates both lungs'
trachea and bronchi. The vagus portion is a sensory nerve that relays
information about lung expansion levels to the brain, as well as the levels of
oxygen and carbon dioxide.
Within the lungs, the activation of the vagus nerve reduces the respiration
rate and deepens the breath. Breathing appears to be slower during the rest-
and-digest process and comes from the diaphragm rather than the breathing
accessory muscles, so the breath rate tends to be lower. A steady, deep breath
rate will activate the vagus nerve and trigger the relaxation reflex when a
person is transitioning from a combat-or-flight state into a rest-and-digest
process.
Vagus tone is required in the pharynx, larynx, and trachea to open the airway.
The pharynx and larynx muscles are innervated by the VN motor
components. Such neurons ' suboptimal activity may contribute to obstruction
of the airways, as occurs in chronic obstructive pulmonary disease (COPD)
and obstructive sleep apnea. Both of these symptoms are a symptom of low
vagal tone and an activation of the vagus nerve. I would also go so far as to
suggest that narrowing of the airways could be a possible root cause of vagus
nerve dysfunction-something that will be addressed in far more depth in later
chapters.
CONTROLLING YOUR MANNER OF BREATHING
Your heart beats to bring blood filled with nutrients and oxygen into each of
your cells and to take toxins to the organs that will dispose of them. The VN
plays an important role in ensuring the heart rate stays within a healthy range
when the body is not under stress. Without the VN, our heart would not be
functioning close to its optimum pace.
The vagus nerve is attached directly to the sinoatrial node, which sends
electrical signals to the two atria (the thinner chambers at the top of the core).
It is also linked directly to the atrioventricular node which manages the
ventricles ' pumping rate and contraction pressure (the two thicker, lower
chambers of the heart).
The sympathetic nervous system stimulates the heart during fight-or-flight
periods to increase the beating rate and the strength of the contractions in
both ventricles. After the stressor exits, the rest-and-digest process takes over,
and the body progresses into a period of vagal activation. At this time, the
VN's parasympathetic fibers slow the heart rate and actively lower the
pumping contractions pressure. These fibers function to lower heart rate,
allowing the heart to relax and heal from stressful times and extreme
activation.
Blood pressure is a determinant of the volume of fluid that is present in the
bloodstream. The kidneys work to flush out the body's fluid and contaminants
and are therefore, the main controller of blood pressure in the body. The
vagus nerve relays information from and to the kidneys to help it control the
flow of water and fluid from inside the kidney glomeruli, the kidney's
essential filtration unit, thereby controlling the body's total blood pressure.
When the body is under stress, via the vagus and sympathetic nerves,
impulses from the blood vessels (in particular the carotid muscle) are
transmitted up the brainstem and back down to the kidneys. The kidneys then
narrow their blood vessels and raise blood pressure by raising the amount of
water from the bloodstream that is drained out. When the body is
comfortable, carotid body signals tell the kidneys to pump out more water
and dilute the blood vessels to relieve blood pressure.
Hormones, interacting with the vagus and sympathetic nerves, are also
closely linked to this cycle. The immediate control, therefore, comes from the
nerves, and the hormones dictate the slow, incremental management.
High blood pressure is a very common condition, and to regulate these levels,
drugs are also prescribed. High blood pressure may be a symptom of
overactivation of the adrenal glands ' stress receptors, and the stress response
mediated by the sympathetic nerves. It is also a very common symptom of
defective vagus nerve and weak vagal sound.

CONTROLLING THE MANY FUNCTIONS OF THE LIVER

The vagus nerve relays a great deal of vital information from and to the liver,
regulating its almost 500 functions. I'll cover just a couple of the roles that are
more widely recognized in this section.
The liver regulates where blood flows inside the body. As the body moves
into fight-or-flight mode during periods of stress, blood flow is forced
towards the arms and legs to increase muscle activation and encourage us to
fight off an attack or run away from it. Blood flow in the liver should decline,
as digestion and blood filtration are not a priority for survival during this
traumatic event. Once the body is relaxed and at rest-and-digest, the
activation of the vagus nerve increases, and the blood flow to the liver
increases. At these times, priority is given to feeding, blood filtration, and
other cellular thriving functions.
The vagus nerve also regulates the liver cells that contain bile and bile salts,
as well as moving bile into the gallbladder and small intestine. It has been
shown that these cells, called cholangiocytes, are activated when the vagus
nerve is activated and increases bile flow to the gallbladder for storage.
Bile performs various liver and body functions. In a two-step cycle, the liver
detoxifies fat-soluble contaminants, producing a water-soluble waste product
that requires releasing. Bile contains certain toxins that are made harmless
and ready to be released from the body through our stool via the digestive
tract. Stool is only one of three routes for removing the waste materials.
Some waste management forms are as urine through the liver, or as sweat
through the skin.
Bile salts, the bile's powerful component, have another role to play. When
bile is released into the small intestine, waste product and ball salts are
released. The bile salts are needed to escort triglycerides (fat molecules) from
the digestive tract, through the enterocytes (cells lining the small intestine),
and into the bloodstream. Fats can not be consumed without being
accompanied by bile salts, which is a bad thing because fats and cholesterol
have many important functions inside the body. That also results in fatty
stools. The role of the vagus nerve in this process is to stimulate
cholangiocytes and to open the flow of bile from the liver into the gallbladder
and from the gallbladder into the small intestine, thus ensuring that the
enterocytes can consume fat.

ACTIVATING GALL BLADDER EMPTYING

When the liver releases bile and the cholangiocytes transfer the bile into the
gallbladder, it is stored and matures, like a fine wine, until it is essential.
When eating a meal, the taste buds in the tongue and the rest of the mouth
transmit messages to the brain, letting our body know about the
macronutrients it tastes as part of every bite and the whole of the snack or
meal. When the central nervous system suggests that fats are being ingested,
then the vagus nerve will soon signal that bile will be required for the liver
and gallbladder.
After receiving this signal, the gallbladder stimulates the smooth muscle cells
in its lining and pumps the bile out into the small intestine through the bile
duct to aid with the absorption of food. The gallbladder will stay complete
without this vagus nerve signal, and will not pump out the requisite bile–a
condition known as obstructive cholestasis.
The removal of the gallbladder, called cholecystectomy, is one of the most
common procedures taking place in hospitals and clinics in North America.
Obstructive surgery to remove a gallbladder, such as gallstones, is often the
first choice available to patients who start experiencing pain associated with
obstructive cholestasis. Unfortunately, most patients don't get the chance to
assess the root cause of this disease.
Gallstones are a painful problem which can affect the gallbladder. After a
long time of low vagus nerve activity, gallstones develop in the gallbladder
which would prevent the gallbladder from properly pumping out bile and bile
salts. If bile salts remain long in the gallbladder, they start crystallizing and
forming stones. This appears to occur with a lack of activation of the vagus
nerve and is an early sign of dysfunction of that nerve. In clinical settings, it
has been shown that gallstones may be produced in early cases of this disease
when the vagus nerve starts to function at a higher level. Performing some of
the vagus nerve relaxation exercises and treatments that we will explore in
later chapters can be very helpful for those struggling with cholestasis and
gallstone formation pain triggered by gallbladder.

MANAGING HUNGER AND SATIETY

Satiety is achieved as our brain receives vagus nerve signals. We need signals
from the liver to be satiated, meaning we have enough fat, protein, and
carbohydrates in the body. All carbohydrates and fats are metabolized in the
liver.
The following regulation is regulated by the vagus nerve in terms of
carbohydrate metabolism: As blood sugar levels slowly decrease, afferent
vagal fibers in the liver increase activity and signal to the brain that more
carbohydrates are needed by the liver cells. However, this pathway does not
signal abrupt increases in blood sugar; these are detected directly inside the
brain.
The small intestine releases a hormone called glucagon-like peptide 1 (GLP-
1) as a response to increased levels of blood sugar which the body translates
as satiety. Diminishing levels of GLP-1 stimulate the vagus nerve, which in
effect manages a gradual reduction in blood sugar. Many pharmaceutical
companies are now developing drugs that function along the GLP-1 pathway
to help control hunger; however, stimulating the vagus nerve will handle this
within your own body.
The vagus nerve provides yet another road to satiety feelings. After eating a
meal, vagal afferent neurons transmit information to the brain about the
amount of fats, particularly triglycerides and linoleic acid, that have made
their way to the liver. This activates the role of the vagus nerve and sends a
signal to the brain which creates a feeling of satiety and a desire to stop
eating.
An underactive vagus nerve may not be able to send the signal efficiently,
resulting in constant feelings of hunger, lack of satiety, and overeating at
mealtime. During a meal, it should take less than 15 to 20 minutes to feel
complete when the VN is functioning effectively. When you know someone
who loses the feeling of satiety, and their appetite continues even after a big
meal, they probably suffer from VN dysfunction.
MANAGING SUGAR AND INSULIN LEVELS
Blood sugar and insulin levels and levels of type II diabetes are rising at
exorbitant rates. Obesity and appropriately called diabesity–combined
diabetes and obesity–are significant signs of a lifestyle that is unhealthy.
Weight issues and concerns with blood sugar regulation are major indicators
that something about the body is functioning suboptimally.
The bodies change their focus towards the sympathetic nervous system
during periods of stress and release more of the adrenal stress hormones,
specifically cortisol. Cortisol's primary effect is to raise blood sugar by
inducing a mechanism called gluconeogenesis, which is when new glucose is
produced from fat and protein processed in the hepatic system.
In short bursts, it is necessary to use the sympathetic nervous system to keep
us alive and to allow us to survive. This fight-or-flight mechanism developed
in response to external threats to our survival-think of our ancestors trying to
run away from a sabre-toothed tiger. In this case, our bodies have to change
to survival mode when the stressor hits us. We either have to combat the
assault, or take the flight and run as quickly as possible.
Our skeletal muscles need significant energy-forming resources to promote
the fight-or-flight response–ideally, the fastest-acting and most easily
accessible way to form cellular energy, which would enable us to survive the
threat. Our bodies can generate glucose rapidly, use gluconeogenesis for
short-term fuel, and transfer it through the bloodstream. The sympathetic
nervous system rapidly transfers blood flow to the arms and leg muscles to
make us extra powerful and quick, thus moving it away from the digestive
tract and kidneys. We will then easily use our muscles to fight the threat or to
run away as fast as humanly as possible.
The problem with this method is that it is always more involved than is
completely appropriate for longer periods. Under the constant stress that we
face at work and at home, with our jobs, relationships, friends, and families,
and because of biochemical stressors and stealth infections, our bodies
continue to remain in the fight-or-flight state far longer than they should, so
we don't move back to the rest-and-digest state in which the parasympathetic
recovery system is predominantly involved. The failure to turn back allows
the liver to generate glucose continually, which in the longer term contributes
to higher levels of blood sugar. The pancreas is triggered to produce insulin
in response to the high blood sugar levels. Insulin is the messenger that
signals to each of our cells that they take glucose from the blood and use it to
produce energy.

HOW WE PROCESS INSULIN

I like to think of insulin like Girl Scouts dropping by, knocking at your door
and giving you cookies every now and then. If every house on your block is a
muscle cell, then insulin will come knocking each time blood sugar levels
rise. The Girl Scouts will knock at your door once or twice a day, though not
too loudly in an ideal situation. In this case, the insulin receptors on the
muscle cell play a role in your entrance. Each time they knock at your door,
you open it and happily accept the offered treat. You will initially be sensitive
to the knock at the door much as our cells are preferably sensitive to insulin.
The Girl Scouts come and pound at your door with all their might when
blood sugar levels rise and spike really high because they need you to take
the cookies because soon as possible so they can move on to the next house
and do the same. It occurs when the scouts have a wagon full of cookies and
need to sell them before their next shipment arrives as soon as possible. I can
imagine they'd be pushy and ask you to take several boxes, not your usual
order. This would be okay once in a while, and by this, you wouldn't feel
stressed or upset. However, if they came banging three, four, and even five
times a day at your door, it would become a problem. When this banging on
the door continued many times a day, you'd probably get irritated every day
for a week. By the end, you'd even avoid answering the bell. You'd become
immune to the Girl Scouts in the same way our cells are insulin resistant.
Once our cells are insulin resistant, they simply stop reacting to insulin at the
threshold. They won't take in the treats insulin offers anymore. It results in
higher levels of insulin and higher levels of blood sugar.
If this same problem starts with each house on your street, and then with each
house in your neighborhood, the Girl Scouts will finally have no choice but
to avoid coming to the neighbourhood. When their sales rates drop, the
suppliers of cookies will stop sending them cookies and then send them to a
storage facility. The storage facility is code, called adipocytes or adipose
tissue, for our fat storage cells. This tissue is found throughout the body, but
the body put the majority of it most efficiently in the central region of the
body: the belly. This helps the arms and legs to work during fight-or-flight
periods when muscle strength is still required.
In this example, if the Girl Scouts stop coming to your neighborhood and
knocking at your door, the insulin supply has effectively burned out and is no
longer effective. This is type II diabetes that happens when the pancreas has
burned out for such a long time after generating too much insulin. It couldn't
control all the blood sugar spikes anymore, and thus stops functioning.
Diabetic patients are also administered medications that either increase
insulin sensitivity, or insulin itself is given to help regulate blood sugar.
Chronic stress, chronic overeating, and a high-sugar diet are often at the root
of this problem and are some of the most common causes for obesity, insulin
resistance, and diabetes production.
So what does the vagus nerve have to do with all of this? Just as we discussed
before, our bodies are under long-term and persistent stress, leading to
inactivity and weakening of the vagus nerves. Our bodies should spend the
vast majority of their time in the rest, digest, and regeneration phase that is
activated by the vagus nerve, under optimum circumstances. When this
system is working, it should help increase insulin sensitivity and enable
gluconeogenesis to be reduced in the liver. The liver function should change
from the bloodstream towards digestion and filtration of toxins. The VN will
also send signals to the liver asking for the development of a signaling
molecule called a hepatic insulin sensitizing product, which increases the
responsiveness of insulin and the concentration of glucose in the cells.
The key thing to note is that to activate the rest-and-digest mechanism and
increase our insulin sensitivity, lower blood sugar levels are required. When
triggered, the vagus nerve is also actively involved in regulating blood sugar
levels via the pancreas, which is a significant cause for insulin output and
secretion.
The pancreatic islet cells generate and secrete insulin in response to elevated
blood glucose levels. The insulin production increases as glucose increases.
A spike in blood sugar levels will lead directly to a spike in insulin release,
and frequent chronic spikes will result in insulin resistance and eventually,
diabetes, as mentioned earlier. A hormone called cholecystokinin (CCK),
released after a meal in the gut, immediately activates the vagus nerve, which
then signals insulin release to the islet cells as required.
To ensure adequate signaling from the gut to the brain and from the brain to
the pancreas, the vagus mechanism must be optimized. Owing to chronic
defective signaling, less than ideal function can inevitably lead to a disease
state. To avoid insulin resistance and, ultimately blood sugar dysregulation
and diabetes, we need to be able to activate the parasympathetic vagus system
with regularity.

MANAGING THE RELEASE OF DIGESTIVE ENZYMES

FROM THE PANCREAS
The pancreas is not only active in the regulation of blood sugar; it is also very
important for the production and secretion of digestive enzymes in the small
intestine in response to a meal.
As we feed, our small intestine taste buds and sensory cells transmit signals
to the brain that decide the precise macronutrients present in the meal. Was it
protein, fat and/or carbohydrate in the meal? How much of the digestive tract
has reached each, and how fast? If the answers to these questions are decided,
the vagus triggers the pancreas to release various digestive enzymes–
proteases, lipases, and amylases–to assist in the breakdown of such
macronutrients, enabling our cells to absorb such nutrients and ultimately use
them properly.
The pancreas secretes proteases to help break down the bonds between the
amino acids which make up the proteins in response to higher protein levels.
The pancreas secretes lipases to help break down triglycerides into
cholesterol and free fatty acids, in response to higher levels of fats.
Eventually, amylase is secreted in response to higher levels of carbohydrates
to help divide complex carbohydrates into simple sugars.
Without this process, the essential macronutrients needed for cellular function
would not be absorbed by our bodies. Amino acids are mainly involved in
making new proteins within our cells, including protein and peptide
hormones, neurotransmitters, receptors, and other molecules for intracellular
signaling. The free fatty acids and simple sugars are mainly used for the
production of energy, while the cholesterol portion of the fats is used as a
precursor to steroid hormones such as estrogen, testosterone and cortisol. All
these molecules are important for cellular function, so to ensure that these
molecules make it into the body, an optimally functioning pancreas is needed.

MANAGING GUT MOTOR FUNCTION

The vagus plays an essential function in bringing food from the mouth to the
other end of the digestive tract. We chew the food down in our mouth when
we take a bite of food until it is physically able to be swallowed and
transferred across the rest of the digestive tract.
It's the responsibility of the vagus nerve to move it to the next place as soon
as the meal, or bolus, hits the back of the mouth–the pharynx. To do so, the
digestive tract's sensors and muscles must work properly. When each bite hits
the back of the throat, a stretch reflex in the smooth muscles is elicited, which
alerts the brainstem through the vagus nerve, letting it know where the bolus
is. In addition, the VN signals the smooth muscle cells to engage in motor
activity and force down the food bolus. This method is referred to as
peristalsis.
In fact, this relatively simple task is quite complex and important because the
digestive tract is very long. To extract nutrients from our food and drive out
any unwelcome tourists, we need movement along the digestive tract.
A badly toned VN can be a root cause of a bolus' damaged tract movement.
Chronic constipation and diarrhea are definitely symptoms of low vagal tone
and loss of muscle and nerve stimulation. Some of the main issues that cause
the problem are that we don't chew our food well enough and that we eat in a
rush and too quickly. That is what I call the drive-through effect, as we eat in
a hurry and in a stress-filled environment. We are attempting to trigger a rest-
and-digest cycle when in a state of fight-or-flight.
For now, it is important to understand that food can not travel along this path-
from the pharynx to the esophagus, through the stomach, through all three
sections of the small intestine, and against gravity in the ascending and
transverse colon-without a properly working vagus nerve.

MANAGING THE OPERATION OF THE IMMUNE SYSTEM

Consider this question: Will you be driving a car with no brakes working? A
car has the important function of getting you safely from point A to point B
and the important role of your immune system is to keep you protected from
invading cells and proteins. And just like a car needs a network of checks and
balances, including braking, so the body's immune cells need a specific set of
checks and balances.
The immune system can run amok without its brakes and start attacking
human cells, which can lead to autoimmunity, or even avoid attacking tumor
cells which can lead to cancer. A car can be a very dangerous vehicle without
brake. The immune system can also be very harmful, without a system to
hold it in check. Enter, the nerve to the vagus.

A LOOK INTO THE IMMUNE SYSTEM

The body's protective system is immune system. It protects you from
contaminants and harmful toxins that can contribute to adverse health
conditions, and often do so. This system includes white blood cells which
send out sensors to search for body invaders. We roam through the
bloodstream in an optimally working scenario, identifying proteins and
species that have invaded the body and transmitting signals to other immune
cells whose role is to remove those invaders which should not be present.
In the immune system, there are several forms of white blood cells, often
known as leukocytes, including monocytes, macrophages, neutrophils, mast
cells, and dendritic cells, collectively known as phagocytes; as well as
basophils, eosinophils, lymphocytes (T cells and B cells), and natural killer
cells.
Phagocyte' means simply' cells that consume.' Once they detect dead or dying
human cells, unwanted bacteria, and harmful proteins that should not be
present, they activate and essentially start engulfing the unwanted cells or
proteins, initiating a process called phagocytosis. We break down these
invaders and produce waste in the digestive organs and liver, which is then
washed out of the blood. Every phagocyte detects different invaders and has a
different way of breaking them down, but both of these cells are important
for an efficient and healthy immune system that works.
As well as phagocytosis, mast cells are also strongly involved in allergy and
anaphylaxis, as they produce and release histamine-rich granules. For a
person living with chronic allergies and related reactions, these are likely to
be hyperactive. Through ensuring that we recognize the effects of the disease,
mast cells have shown to be highly involved in autoimmunity. Interestingly,
they are one of the few immune cells in both the stomach and the brain. If
mast cells become overactivated within the brain, the brain's nerves can
become more responsive to pain, leading to inflammation of the brain.
Likewise, when these cells are stimulated in the stomach, they make the gut's
nerves more responsive to pain, contributing to inflammation of the stomach
around the nerves, which can hinder the regular movement of the gut
(peristalsis) motility. As we will discuss shortly, the vagus nerve is the main
controller of gut motility, and hyperactivation of mast cells can be a cause for
dysfunction of the vagus nerves.
Basophils are responsible for inflammatory reactions during an immune
response, and are involved in conditions such as mast cells that cause allergic
symptoms such as anaphylaxis, asthma, atopic dermatitis, and hay fever.
Parasites and allergies can cause them. All of these can usually occur and
reach the body through the digestive tract or broken skin.
Eosinophils are responsible for reacting to parasites and infections and for
battling them. We are also considered, as basophiles, to be involved in
allergies and asthma. Low-grade, chronic parasite, or bacterial infections may
cause overstimulation of eosinophils, which have been shown to trigger
asthmatic and allergic symptoms. Such diseases most often affect us and get
through our bodies via the digestive tract.
The main cells involved in suppressing viruses and tumor development in the
body are natural killer cells. They do not need sensors to recognize human
cells as opposed to invading cells, thus the name of natural killers. The
dysfunction of these cells may lead to tumor growth, and the body's ability to
recognize and fight these cancerous growths can decrease.
The vast majority of leukocytes produce sensors which roam the body's
internal environment to do their job. Such sensors are called
immunoglobulins, or anticorps. These sensors come in five different forms–
immunoglobulin A (IgA), IgE, IgG, IgM, and IgD. Each of these sensors has
a different function and speed, at which the white blood cells are signaled to
respond.
IgG is the most abundant sensor and is located on mature immune cell
surfaces. Its function is to identify non-present cells and proteins, and to
activate a pathway which leads to inflammation and immune activation.
IgA is the second most abundant sensor, and a particular subset of IgA
(called secretory IgA) is dispatched to our body fluids such as breast milk,
saliva, and digestive tract secretions. Secretory IgA is important for
recognizing possible threats, like mouth, to the digestive tract. High levels of
IgA indicate the existence of bacteria, viruses, parasites, and yeast while low
levels of IgA suggest dysfunction of the immune system due to persistent
activation by these same invaders. In my patients, I test secretory IgA levels
to assess their current immune function and activation status. This is a very
important and versatile instrument used in the practice of functional
medicine.
They are much less popular in IgM, IgE, and IgD. They are located on the
surface of mature immune cells, and have a feature similar to IgG.\
The mechanism is regulated through the vagus nerve to keep immune cells in
place. A significant pathway called the cholinergic anti-inflammatory
pathway is needed to set off a properly functioning vagus nerve. The pathway
keeps the immune system in check when involved, and pumps the brakes
when needed. Vagus innervation to the digestive organs, such as thymus,
spleen, and intestines, is strongly involved in stimulating the pathway. It's
important to understand how these essential organs function inside the
immune system before you know about the pathway itself.
The main lymphatic organ is the thymus. It produces primarily T-cells, white
blood cells which try and kill foreign invaders. To activate it, the vagus nerve
sends a branch to the thymus, while it can be deactivated by sympathetic
fibers that connect to this organ. The thymus, on average, is fully functioning
until we reach puberty when it begins to shrink and decrease in both size and
function. This mechanism is called thymus involution. Recent work has
shown that our high-stress lifestyle and sympathetic branch hyperactivation
will contribute to earlier thymus deactivation. This is thought to be a root
cause of autoimmune disorders and an increased risk of bacteria, viruses, and
other pathogens being infected.
The immune systems have been developing and evolving earlier in the lives
to build a mechanism that helps to protect us from invasion by bacteria,
viruses, and other pathogens that should not enter our bodies. It is a complex
device, one that takes years of training and practice to cope with the body's
invaders. Overstimulation of the thymus may occur via parasympathetic
fibers, leading to excessive organ development, but this is not very common.
The much more common issue is that there is a higher degree of sympathetic
activation, which ultimately unnecessarily deactivates the brain.
So long as you have a thymus that functions well, the body is covered as it
grows. The thymus functions as a classroom, or immune cell training center,
the body's police officers. It continues to churn out professionally trained, and
highly educated police officers who defend our cells from threats as long as
this training center is operational and fully funded. If the support for this
school declines, fewer, less well-trained officers are released, and the
standard of security withers, placing us at a much higher risk of invaders
infection.
This illustrates why we are at a higher risk of infectious disease when we
grow older and also why we are at a higher risk of autoimmune disorders
following extremely stressful events in life. Our immune cells are not
sufficiently suited to separating invading cells from our own cells in an
autoimmune disease. When we age, we are subjected to stressful life
circumstances, thus growing levels of autoimmune disorders including, but
definitely not limited to, Hashimoto thyroiditis, rheumatoid arthritis, multiple
sclerosis, Crohn's disease, ulcerative colitis, and many more.
The spleen is the next target for immune system cells. Speak of the spleen as
the White and Red blood cell buffer. It ensures there are only eligible,
professionally trained immune cells in the body's bloodstream and other
tissues. It will remove and filter out any cells which reach the end of their
optimum operating period. The spleen acts as a test and balance for
bloodstream immune cells. It ensures that the immune system defends against
pathogens while operating optimally while not behaving aggressively against
our own cells. The vagus nerve relays back and forth information from the
central nervous system to let our bodies know which cells are drained out of
the blood.
As with the thymus and so many other organs, the vagus' parasympathetic
activity is necessary to keep the spleen active, while the sympathetic activity
may decrease or shut down splenic activity temporarily. Chronic stress or
activation of the sympathetic branches would inevitably contribute to
consistently decreased levels of spleen activity, and low white and red blood
cell filtration in turn. This leads to an increased risk of autoimmune disease,
because the less-qualified wandering "police officer" is not held in check and
can not differentiate between invaders and our own cellular proteins.
The immune cells nearest to the region determine the danger and release
proteins called cytokines to attract additional cells that will assist in the
immune response when a damaging event happens in the body or when
invaders are identified. Such cytokines are identified by afferent fibers of the
vagus nerve, which send signals back to the brain to warn it of the type of
inflammation that is developing. Recent work has also shown that cytokines
may be identified by the vagus nerve.
The intestine is the most common place where pathogens will reach the body,
and as such, the vast majority of our immune cells are found in the gut lining.
Throughout the digestive tract, they are kept in small pockets which we
affectionately refer to as gut-associated lymphoid tissue (GALT). In the gut,
the vagus nerve functions are very extensive and essential in order to ensure
optimal health. It helps to regulate immune and inflammatory responses,
allow us to build memories and relay information between the bacteria in the
gut and the brain. The next three parts address those positions.
MANAGING INFLAMMATION IN THE GUT
Continuing the discussion of the effect of the vagus nerve on immune
responses in the intestine, we will address what is perhaps the most important
function of the vagus' anti-inflammatory cholinergic pathway. Using the
neurotransmitter acetylcholine (ACh), the vagus nerve sends signals
throughout the body to the cells of the immune system, but particularly strong
signals in the gut. These signals are meant to soothe immune function and
reduce inflammation.
Afferent vagus activity in the thymus and spleen has been shown to increase
in response to stressors like lipopolysaccharide (LPS), a toxin that is created
and released by one of two forms of bacteria, and invaders such as bacteria,
viruses and parasites in our gut. Around the same time, the nervous system's
sympathetic branch, the fight-or-flight response, makes sure immune cells are
ready to attack the invaders. Once immune cells first sense the presence of
these unwanted stressors in the intestine, they send a signal to the GALT,
triggering a stress response and sympathetic nerves. The sympathetic nerves
then signal norepinephrine (NE), also known as adrenaline, to the
neurotransmitter. NE stimulates the cells of the immune system that are
highly susceptible to threats and stressors. This system is very useful, but
brakes are required for optimal operation as with all important systems.
Parasympathetic activity is carried out through the vagus nerve in the vast
majority of the heart. The role is to regulate inflammation and immune
response. To combat the pro-inflammatory reaction of sympathetic nerves
and norepinephrine, the vagus nerve and its branches send out ACh in the gut
and other areas of the body. The ideal balance between sympathetic NE
secretion and parasympathetic ACh secretion occurs while functioning
optimally. This keeps our health in check by triggering an immune response
when needed and turning it off if it is not needed. Control of a feature comes
from turning it off.
During response to higher levels of stress and immune function, ACh is
released from the vagus nerve. The release is massively and efficiently
intensified by the enteric nervous system, a group of nerve cells in the gut
which is so huge, it is also known as the second brain. Others claim that the
enteric nervous system in our head is more important than the brain, as the
relationship between this system and our microbiome determines much of our
safety.
A significant receptor located on the surface of most white blood cells -
thealpha-7 nicotinic acetylcholine receptor –promotes the immune cell effect
of ACh. This receptor works to lower activation and slows down the immune
response when it is not needed. The parasympathetic and sympathetic
stimulation of inflammatory response in the gut is essential in balancing.

RELAYING KNOWLEDGE FROM THE MICROBIOME

Microbiome work has been the biggest contribution to our wellbeing in the
course of centuries. Every day we are learning new exciting stuff about the
bacteria population in our gut and its effect on our wellbeing and
biochemistry. For the vast majority of our nutritional intake,
neurotransmitters, our mood, and even how our brains function, this
population is responsible.
Our digestive tract comprises almost 100 trillion bacterial cells, much more
than the number of human cells in our body. Such bacteria have a particular
breakdown of the population that can affect nearly every part of our health
and wellbeing. Signal transmission from the gut to the brain happens most
rapidly through the vagus nerve and is augmented by the bloodstream and
hormonal systems.
For all the other organs and processes regulated by the vagus, the intestines
and bacterial changes are more likely to be felt. Unlike our heart, liver, or
spleen, we can "tune in" to our gut and what is happening in there. A desire is
the commonest example of this. As stated in a great book called The
Psychobiotic Revolution, written by Scott Anderson, John Cryan, and Ted
Dinan, Your cravings are most times just committee memos sent up from
your gut microbes. They consist of a full list of the carbs, sugars, and fats
they are in search of.
The book proceeds to address the example of Bifidobacterium (a.k.a. Bifido),
a genus of bacteria found in our gut in high proportion: certain microbes,
especially our friendly Bifido species, produce butyrate that feeds and heals
your gut lining. Butyrate can make its way to the brain, where it can promote
good mood, humidify inflammation, or stimulate the development of a
hormone for brain growth. Both these improvements will enhance your mood
and even help you think better. "The genus Lactobacillus (a.k.a. Lacto) is
another form of bacteria that is discussed in this book. Anderson, Cryan, and
Dinan elaborate: In experiments with IBS sufferers, it has been found that
certain species of Lacto directly stimulate the opioid and cannabinoid
receptors in the brain, functioning more like a morphine shot. Unlike the
addiction to the high of a runner, this form of reaction will induce cravings
for whatever food your Lacto microbes prefer. You may think your cravings
are all in your head, but chances are they start with your gut bacteria.
When we understand that cravings and signals about the foods that our
bacteria want are actually transmitted via the vagus nerve and into our
bloodstream, it is possible to take back control of our decisions and make
dietary improvements that can have a beneficial impact on our microbiota
and overall health.

ALLOWING US TO BUILD MEMORIES

Recent work has shown that both the growth and maturation of the enteric
nervous system and the central nervous system involve the involvement of
gut bacteria. As described above, the vagus nerve is strongly involved in
relaying microbiome information from the intestinal bacteria to the brain.
This coordination chain may be responsible for initiating the development of
a protein called neurotrophic factor (BDNF) derived from the brain. BDNF
activation contributes to increased neuronal integration, and most
importantly, to memory production in the brain.
This means it can be difficult to develop new memories and establish new
neuronal connections without gut bacteria and a healthy working vagus
nerve. To an even greater degree, this ensures that if you have an optimally
working vagus nerve, you are likely to be able to create broader memories
and connections with the world around you and others who matter to you.
We are creating barriers during our fetal development to shield us from
external threats. One such barrier is the gut-blood barrier which protects us
from bacteria (both good and bad) that may want to invade. It is made from
the same cells that build our barrier to the blood-brain. It means that any
inflammation that happens in the intestine and breaks down the gut barrier
also has the potential to break down the blood-brain barrier.
Have you ever stepped into a house, and forgot why you were going into that
house? Have you ever wanted to say a very easy thing but couldn't find the
right words to say? Such problems are generally referred to as "brain fog"
and are caused by inflammation levels in the brain that are higher than
normal. Brain fog happens when the blood-brain barrier has partially broken
down, and inflammatory impulses are allowed to penetrate the brain tissue,
reducing neuron activity.
Brain fog suggests the presence of inflammation in the brain caused by a less-
than-optimal blood-brain barrier, and thus poorly working gut lining or leaky
intestine.
***
Vagus is obviously much more essential than basic biochemical and
physiological functions. How does it manage to do all at once?
 CHAPTER 4

HOW THE VAGUS NERVE MANAGES IT ALL

Neurons act to relay messages to other body cells. Such signals may be for
muscle control, proprioception (stimulus reception), active brain thought,
and, of course, unconscious processes that take place in the autonomic
nervous system. To have the signal of a neuron reaching the expected cells,
three things have to happen:

1. The neuron needs to transmit an electrically charged signal all

along its length.
2. The neuron requires a protein called a neurotransmitter to be
released into the space between itself and the cell it wants to
influence.
3. The neurotransmitter must fit on the surface of the next cell into
a protein receptor and induce action inside it.
Most neuron impulses need to function optimally in the case of the vagus
nerve so that it can perform all of its tasks.

SENDING THE SIGNAL THROUGH NEURONS

As you read in Chapter 1, about 80 percent of the signals transmitted along
the vagus come from the organs to the brain–an positive message. You
learned that these signals relay information about the current state of
operation, when something goes wrong and what immediate attention is
required. The vagus, which is the longest nerve in the body, communicates
information from the liver on detoxification, bile production, and blood sugar
balance; from the digestive tract on the digestive cycle, food movement, and
microbiome; and most importantly, from the cells and organs of the immune
system on their working condition. This also relays knowledge about their
levels of operation from the heart and lungs, and any impairments that arise.
The signals are distributed by very long neuron cell axons and dendrites, the
long arms and legs. It's really necessary that the signals will strongly transmit
from one end of the neuron to another. As I’m sure you can understand, these
impulses have to travel distances to the brain like the intestines and kidneys.
The vagus neurons need an insulation level to efficiently transmit these
signals. If an electrical cord carries a signal through a metal wire, the cord
requires insulation in the form of a material wrapped around it that does not
conduct electricity, such as plastic or rubber. It means the electrical charge
within the cord remains. However, if a wire is frayed, it does not transmit the
signal strongly, and can dissipate and weaken until it enters the brain.
Our cells store fat to insulate the nerves and ensure that the signals pass from
one end to the other rapidly and effectively. Most of our body's nerves are
covered by Schwann cells, and the vagus nerve is no exception to this.
Schwann cells build an isolating shield around neurons, called a myelin
sheath, which protects signals and effectively ensures nerve function. Any
damage to these Schwann cells may, in fact, result in isolation "fraying" and
inadequate signaling along the nerve. We are starting to develop this myelin
sheath though at 24 weeks of development we are still in the womb of our
mum. The myelin continues to grow up to around 40 weeks when we are at
full term. This myelination rate remains about the same until we hit teenage
age when it begins to decline. The Schwann cells and myelin sheath ensure
signals make it from one end to the other of the vagus.

RELEASING THE CHEMICAL MESSENGER

When an electrical signal reaches the end of a neuron at the terminal axon
region, the signal generates a charge that causes the release of a
neurotransmitter from the cell. There are several different neurotransmitters
in the body, including NE and ACh, some of which I stated earlier. The vagus
nerve uses ACh as its neurotransmitter, almost exclusively.
ACh needs to be formed from two distinct structures: acetyl coenzyme A
(acetyl-CoA) and choline. The glucose and free fatty acids are broken down
into acetyl-CoA via different metabolic processes. Such metabolic reactions
require optimum functioning of different micronutrients. Our cells need
adequate amounts of carnitine and vitamin B2 to metabolize free fatty acids,
while our cells need high amounts of vitamin B1, vitamin B3, chromium,
lipoic acid, and coenzyme Q10 to metabolize glucose. Unfortunately, as
shown by research, these nutrients are usually missing in our bodies. The
practical laboratory testing of urinary organic acid will help ensure that this
cycle occurs efficiently and that nutrients are available to fulfill those
obligations.
On the other hand, choline is an organic compound that originates from
certain amino acids. This is considered an important food for humans, which
means that it can not be produced in our body–it must be included in the diet.
The highest-quantity foods containing this compound are egg yolks, soy, and
beef, chicken, and turkey livers. Sometimes, it is a part of soy lecithin that is
used as an additive in many food products.
In the neurons, acetyl-CoA and choline cross to form acetylcholine. ACh is
released from the neuron axons of the vagus so that it can affect the various
cells and organs regulated by this nerve. This process ensures that the second
nerve function requirement is met by releasing a neurotransmitter into the
space near the target cell to be carried out. Getting good sources of acetyl-
CoA and choline is very important for our wellbeing

RECEIVING THE SIGNAL IN THE NEXT CELL

When a nerve releases a neurotransmitter, the effect on the next cell is not
immediate. Actually, there is a very small space or gap between the end of
the neuron axon and the cell which receives the signals, called a synapse. The
neurotransmitter is released into the synapse, and must be present in adequate
amounts to find its way to the next cell's receptor proteins.
In the case of the vagus nerve, ACh is released into the synapse and binds on
the surface of several different cell types to receptor proteins. The receptor
protein used by these cells to receive ACh signals from the vagus is either the
fast-acting nicotinic acetylcholine (nAChR) receptors or the slower
muscarinic acetylcholine (mAChR) receptors. To receive the signals from the
vagus, each receptor cell must have its own unique type of AChR and induce
a response within the individual type of cell. Most tissues and non-neuron
cells express the nicotinic receptor, while the muscarinic variants appear to be
expressed by other neurons in the central nervous system.
Some circumstances can cause the output of receptors on receptor cells to
decrease or even rise. One of the most important is the presence of LPS,
which is sent in by opportunistic intestinal bacteria and causes the bowel cells
to break down. The gene that holds the blueprint for this protein in the
presence of LPS possesses the ability to become substantially more or less
active. This can explain why some people are extremely prone to changes in
the inflammatory gut, and others are less susceptible. Regardless of the
degree of sensitivity, LPS is a catalyst for changes to this gene and causes
problems with concentrations of the receptor protein.
 PART 2

ACTIVATING YOUR VAGUS NERVE

CHAPTER 5

MEASURING VAGUS NERVE FUNCTION

Anything that can be measured can be changed.
We have a saying in functional medicine that we keep tight and pledge to
work with: We don’t guess –we test. Determining the activity of the vagus
nerve is no exception here. Although we can base many of our suggestions on
the symptoms a patient has, there is no substitute for an objective test that
tells us the best steps to take for each particular patient.
In this chapter, I will address the four methods we use to assess the
functioning of the vagus nerve and determine if the VN functions optimally
or needs training. Such techniques are the calculation of variation of heart
rate, breathing rate, breath rhythm, and transit time in the bowel. The most
important thing to keep in mind is that nobody should alter something that
can be calculated. When you check the vagus nerve output, and it isn't ideal
at the moment, you'll be able to trigger it and improve its work when you
make the effort to do so individually.
HEART RATE VARIABILITY
Heart rate variability (HRV) is the gold standard for assessing the activity of
the vagus nerve. No single test is known to represent the activity levels of the
vagus nerve and vagal tone in a stronger and more precise way. It is
measured most accurately in a laboratory setting using very costly and
advanced equipment, but we can calculate it at home with a fair amount of
precision with appropriate investment.
Note the vagus nerve has the purpose of calming down and controlling the
heart rate to a relaxed pace of rest. There are four chambers in the heart: the
left and right atria, from which the blood reaches the heart, and the left and
right ventricles, which pump the blood through the blood vessels so that it
can circulate the rest of the body around it.
A pounding heart's "lub-dup", in fact, reflects the two phases of the heartbeat.
The heart's first pump–the "lub part" reflects the operation of the left and
right atria's muscle walls, pumping blood into the ventricles. This process
reflects the thicker ventricular walls pumping blood into the aorta and
pulmonary artery, delivering oxygenated blood to the body's cells, and
deoxygenated blood to the lungs. After the "lub-dup," there is also a brief
period of time called an "interbeat interval" during which there is no
anticipated electrical activity in the heart.
Heart rate variation is the calculation of time between consecutive heart
pumps in milliseconds, the time from the end of a "lub-dup" to the beginning
of the next "lub-dup." Whether and how much time between pumps varies is
a significant predictor of both autonomic and cardiovascular safety. The more
active the vagus nerve will be, the lower the heart rate will be within an ideal
zone and the more variable the time between your heart pumps will be.
Unless the heart had no innervating parasympathetic or sympathetic nerves, it
should pump at around 100 beats per minute (bpm). Sympathetic innervation
will increase heart rate to around 120 bpm. A heart rate of about 120 bpm is
very high and means that around two heartbeats occur each second. This
means that between each pump of your heart, there'll be around 400 to 450
milliseconds of time. This should be called low HRV, as the time between
pumps remains fairly constant –the difference between beats is at most 38
milliseconds.
In comparison, parasympathetic innervation tends to lower heart rate and
improve variability in heart rate. HRV can be calculated to assess how well a
person really is and how well their vagus nerve is working when the heart
rate drops down to its usual resting state. The optimum heart rate is between
50 and 70 bpm, and the HRV will differ considerably between pumps. This
can be considered an example of high variability in heart rate, as there are
130 milliseconds of variation between beats. The higher the amplitude of
your heart rate, the more likely you will have a higher fitness level,
cardiovascular health, and vagal tone. High HRV is one of the best longevity
predictors, as well.
As technology is evolving and becoming accessible to the general public,
instruments are emerging that allow us to take control of our health and
calculate these health predictors on our own. I only use two devices and urge
my patients to use them as well.
The first tool I use is HeartMath's Inside Balance app. For those interested in
learning about their heart rate variability and overall health, it is a perfect
simple resource while still continuing to take measures to boost their HRV.
The Inner Balance method helps you to change the heart rhythm and to
transmit positive health and longevity messages to the brain through the
vagus nerve. The aim of HeartMath and the Inner Balance method is to reach
a state called coherence and to consistently increase your HRV. Our HRV is
strong when we are in a state of stability, and our bodies function in an ideal
condition.
The best thing about this device is being able to use it on your mobile. This
will connect to Apple or Android and provide you with details on your
current level of operation and consistency. This can teach us to reach the state
of coherence, which in high-stress circumstances, is incredibly useful,
particularly for those who appear to be in a sympathetic state.
There are all sorts of new and emerging wearable devices, many of which are
intended to track how the body functions. In determining how to monitor
your results, the most important thing to consider is whether you may be
exposed to electromagnetic radiation or other suboptimal energy fields, and
to what degree. More and more studies show that exposure to different forms
of radiation impacts one's wellbeing less than expected. Many of my
colleagues and I use the Oura Ring since it restricts sensitivity to harmful
electromagnetic frequencies (EMF) when used in aircraft mode. I can share
the data with my computer until I remove it from my body.
Using a technique called photoplethysmography, Oura Ring records
intermission intervals. The best thing about the Oura Ring is that you can
wear it all the time, and when you add a monitoring device, it gives you real-
time data for your entire day. The Oura Ring can monitor your current
condition, your recovery from endurance or training activities, your readiness
to perform a new workout, decreases in activity that could signify an
oncoming infection or cold (even before you get symptoms), sleep quality,
how your body handles stress, and even if you are dehydrated (which may
lead to a drop in HRV).
RESTING HEART RATE AND HEART RATE RECOVERY
Resting heart rate is a simple indicator that shows you how well your body
functions. (If you want to buy one, visit OURAring.com and use the
exclusive "vagus" code to get a discount on your purchase.) If we assume that
the normal resting heart rate is usually between 60 and 100 bpm, but without
any autonomic stimulation, the heart rate will be around 100 bpm, it is
reasonable to extrapolate that the lower the heart rate within the ideal range,
the greater the parasympathetic signaling to the heart.
The normal heart rate will be in the range of 50 to 70 bpm in a healthy
person. Many athletes tend to find their heart rate at the lower end, 50 to 60
bpm, whereas less active but still stable individuals appear to be 60 to 70 bpm
in heart rate. New evidence indicates that a heart rate that sits above 76 bpm
is associated with increased risk of heart attack. In addition, there is a link
between the risk of dying from any cause and a rise in heart rate in both men
and women. Essentially the higher the risk of dying from any cause,
particularly one that is cardiovascular, as the resting heart rate increases.
It is necessary to calculate how quickly the heart rate gets back to its resting
rate after exercise. High-intensity exercise and training are known to reduce
the resting heart rate over time, and regular training is correlated with quicker
recovery times. When after an exercise session it takes you a long time to
recover, this is a sign of poor cardiovascular health and poor vagal tone; note,
vagus signaling is required to slow heart rate and keep heart rate resting.
Optimal recovery from exercise requires a reduction of 12 bpm per minute,
while unhealthy individuals take longer and appear to be less than 12 bpm
downwards.
To calculate the improvement in heart rate, monitor the heart rate a few times
when you are comfortable. You can use a smartphone or wearable devices to
locate and record the number with reasonable accuracy. Then, follow your
daily workout or training routine and check the heart rate immediately at the
conclusion of the session, using the same procedure as before. Between 2
minutes, 4 minutes, and 6 minutes, check again. Your heart rate will drop by
more than 24 bpm after 2 minutes, by more than 48 bpm after 4 minutes, and
should be very close to your original resting heart rate after 6 minutes. That
depends, of course, on how intensive the preparation was, and whether it was
aerobic (e.g., running) or anaerobic (e.g., weight lifting).
When you regularly monitor your heart rate and HRV, you'll note a rise in
HRV following exercise; the vagus nerve is extremely involved during
rehabilitation as it works to rebuild tissues. When exercises and tones
muscles, heart, and spinal nerves in aerobic and anaerobic activity, then
rehabilitation is the training session for the vagus nerve. The more you
practice, the faster you heal, and the more quickly the vagus nerve can fire
when you exercise next time. That is why recovery levels are improving for
those who regularly exercise: the VN is practicing with greater strength and
tone to do their job.

PARADOXICAL BREATHING PATTERN CHECK

Using the diaphragm to continue breathing? Has your breathing habits been
abnormal and your vagus nervous system function less than optimally? It is a
very easy exercise and a tool for teaching yourself to breathe through your
diaphragm.
Sit in a chair straight up, or lay down on the floor on your back. Place the
middle of your chest with your right hand and put your left hand in the
middle of your abdomen. Now give in a deep breath. When your right-hand
works faster than your left hand, then you breathe poorly. Our bellies should
rise and fall more during the inhalation process than our chest does, and if we
are breathing correctly, our left hand will rise and fall more than our right
hand.
Many people would notice that their chest moves faster than their stomach. It
is a sign of paradoxical breathing and shows that someone actually doesn't
use their diaphragm to breathe entirely, deeply, and properly. If you are
paradoxically breathing, don't worry because once again you can train
yourself to become an effective breather. It'll only take some work and a
routine practice to relearn habits you had when you were a kid a long time
ago.

SESAME SEED BOWEL TRANSIT TIME TEST

How well is the food moving through your digestive tract? Does that travel at
an optimum, safe pace? To receive the essential nutrients that come from our
food, we need to process and break down our food on a clear schedule for our
bodies. The sesame seed bowel transit time test will give us some knowledge
about how our digestive tract functions, and whether we need to make any
health adjustments. All you need is a tablespoon of golden or yellow sesame
seeds, a cup of tea, a watch or clock, and a notepad and a pen.
We know our gut lacks the enzymes for digesting and breaking down sesame
seeds (similar to corn), which is what makes them so good for this study. We
all learn that the vagus nerve is the peristalsis driving force and keeps the
digestive tract going at an optimum rate. Any variations in this rate can
indicate a loss of control of VN or any other digestive dysfunctions.
Here's how to get the test completed. Second, apply a cup of water to the
sesame seeds and whisk it around. First, drink the cup of water in it with
sesame seeds, and make careful not to chew the seeds. Look at the time, and
mark it on your notepad or computer. Then wait until the next time for a
bowel movement, when you need to go to the toilet. Every time you go to the
bathroom and have a bowel movement, take a peek at your stools to see if
you see any sesame seed. Label the times and continue to search until you no
longer see any seed. The best time to see the seeds start emerging is around
12 hours after ingestion, and the latest is about 20 hours after ingestion.
Seeing seeds after 16 hours of ingestion suggests optimum digestive
sequence and function.
When your body moves the seeds out too fast, your digestive tract does not
work hard enough, and the VN probably will not fir optimally. When the
body is very slow to extract the seeds, the operation of the vagus will
definitely be reduced. Monitoring the gut microbiome is strongly
recommended in any case, because it may uncover the cause of slow bowel
transit time and potentially weak vagus nerve signaling. Now that we
understand some basic ways to assess VN activity and evaluate how well our
parasympathetic nervous system is functioning, we can get into the exercises
and activities that enhance the function of this nerve and help regulate our
bodies ' cardiovascular, respiratory, immune, digestive, and detoxifying
systems.
 CHAPTER 6

EXERCISES TO ACTIVATE THE VAGUS

NERVE
I'll delve into each of the successful exercises and activities in this chapter
that you can perform to activate your vagus nerve without purchasing costly
equipment. Much literature on this subject shows that frequently conducted
active exercises are as effective as (if not even more effective than)
purchasing tools to activate the VN.
It is all noticed that the activities and exercises addressed in this chapter are
successful in increasing vagal tone. It is important to note that the vagus
nerve is not simply a parasympathetic signaling nerve: The VN has four
different components, each of which can be stimulated to allow the other
three components to be optimally signaled and triggered. Such components
are:
1. skin sensation from the central region of the ear;
2. motor innervation of the pharynx and larynx;
3. parasympathetic innervation of the heart, lungs, and other organs; and
4. afferent vagus neurons that send signals back to the brain through visceral
fibers. Keep these four components in mind as we go through these exercise
options.

BREATHING EXERCISES
The first and most important way of getting a good effect on your vagus
nerve is to learn how to breathe properly. Simply put, quick, rapid breathing
of the chest is a sign of stress that activates the sympathetic branch while
slow, deep breathing of the belly is a sign of rest that activates the vagus
nerve.
Breath is our one window into the autonomics.
 --Dr. Jared Seigler
The vast majority of us didn't learn to breathe properly. In reality, we taught
ourselves subconsciously to forget the proper mechanics of breathing. Right
breathing habits are closely correlated with autonomic regulation of the
nervous system, and irregular breathing habits notify the body that it is under
stress. This point is compounded even further when you know that the
average human takes about 23,040 breaths every day.
If we want to know the easiest, most secure, and most effective way of
breathing, then we need to look to the leaders and examples who live among
us. Find some of the best artists of our day, vocal and instrumental. If you've
ever been to a concert or opera, you've probably found that excellent singers
and instrumentalists can perform a whole set of songs without much of a
break. In songs performed by greats like Frank Sinatra, Aretha Franklin, and
Celine Dion, the singers never sound like they're out of breath or unable to
hold a note because they've been practicing their breathing patterns. Opera
singers are some of the most effective breathers on the planet; they have
learned to regulate their diaphragm function while keeping their vocal
muscles vibrating.
High-performing professional athletes are also another category to remember.
These are the best of the best, the ones that are not cracking under pressure.
Stars like Michael Jordan, Tom Brady, Cristiano Ronaldo, Tiger Woods,
Wayne Gretzky, Nolan Ryan, Ken Griffey Jr., and Babe Ruth all had one
thing in common, they all managed to monitor their stress rates by ensuring
that their breath patterns stayed perfect while working. To perform at these
high levels, these performers conditioned themselves by using a steady,
relaxed, and relaxing breathing technique to stay calm under high stress
circumstances. You will also learn how to establish an effective breathing
pattern that will signal to your body that you are not under stress, thereby
allowing for effective signaling via the vagus nerve and parasympathetic
nervous system.
Multiple research studies have shown that slow aerobic exercises are highly
successful in improving variability in heart rate. One study found that
slowing the breath rate for five minutes to six full breaths per minute was
successful at instantly increasing HRV. The effect on HRV is much more
successful if this is individualized. Determining the optimum slow breath rate
and feeling good for you personally will have the greatest positive impact on
your HRV rates.
Here are quick measures to bring this exercise into practice:
1. Stand up straight, without making your back rest on something.
2. Exhale and expel all the air from the lungs entirely.
3. Place your right hand on your stomach, and place your left hand on your
back, just above your back.
4. For five to seven seconds, take a deep breath through your nose, allowing
only your belly to rise (feeling only your left hand rising).
5. Hold your breath for two to three second.
6. Exhale for six to eight seconds through your mouth, causing your belly to
fall (simply feeling your left hand falling).
7. Keep your breath for two or three seconds, without any air coming into
your lungs.
8. Repeat steps 4 to 7 or as many times as you feel confident.
Take five minutes a day to practice your own deep belly breathing and your
body will be grateful. Perform this practice multiple times a day for better
results, particularly during stressful periods. Even one minute of
concentrating on steady, deep breathing can have major positive effects on
your mood, levels of stress, and overall health. Try to concentrate your
attention on breathing through your nose instead of your mouth to make this
exercise even more successful when you do it.
If you've already learned to do this basic deep breathing exercise and are up
for something a little more demanding and advanced, I suggest that you try
the breathing exercise at Wim Hof. According to Google, Wim Hof is a
Dutch "daredevil," but in studying his process, I now see him as a visionary.
He is also known as the "Ice Man" because his preparation and technique
require the use of breathing exercises and cold exposure as well as the
practice dedication. Please check out his website www.wimhofmethod.com
to learn more about the method and to take his free online mini-course.

BREATHING HABITS DURING SLEEP

Now that when you're awake, we've explored the value of optimal breathing
patterns. It's time to ask: How about when you're asleep? The average person
needs about seven and eight hours of restful nightly sleep, during which they
take about 7,200 breaths. This is significant, as we take almost one-third of
our breaths when we're not awake. If we are awake and in control of our acts,
we can teach ourselves to breathe optimally, but what about when we're
asleep?
Research has shown that when we are sleeping, we continue to fall back on
bad breathing patterns. This is critical because airway obstructions can have a
detrimental impact on our health and body function when we are not fully
aware. Obstructive sleep apnea is a growing concern and needs to be tackled
if we want our health to improve. Personally, I've been diagnosed with sleep
apnea, and I know that many of you are still having symptoms, although you
may not understand that they are. Only after I married was I made aware of
the issue. My wife pointed out to me that for any excuse I would stop
breathing in the middle of the night, and I was snoring very heavily too. This
has affected my sleep negatively, and as you might imagine, it has sent a
signal of stress to my body, as it has literally shocked my body many times
during the night. It also showed that there was no proper functioning of my
vagus nerve. After I lost most of my excess body fat, the symptoms changed,
but they still persisted from time to time, particularly when I was incredibly
exhausted before falling asleep. It was a challenge before I learned a fantastic
tool from my colleague and mentor Mike Mutzel and Dr. Mark Burhenne,
DDS, who was a guest on Mike's High-Intensity Health podcast. This method
is called mouth taping and I use it all the time now.
Unlike me, Mike had a moderate case of sleep apnea to contend with. Dr.
Burhenne talked on the podcast about this wonderful device and all the
benefits it has. When we stop breathing through our nose, we start breathing
through our mouth straight away. Over time, the lack of circulation via the
nasal passage has a detrimental impact on the nasal microbiome and the nasal
passage lining the cells. This results in inflammation of these nasal passages,
post-nasal drip, and increased responses to histamine, such as seasonal
allergies.
Face taping includes covering your lips with a sheet of tape around your face
when you're sleeping. This effectively causes the airflow to pass through your
nose while you sleep. No single tool has been more effective in enhancing
my breathing habits, allowing me to get a better, more restful sleep and lower
my allergies.
It's much more difficult to use the diaphragm to breathe when we breathe
through our ears, but when we breathe through our nose, it's absolutely
second nature and normal. Studies with HRV have shown that when we
breathe through our noses than pathologically through our ears, we boost
vagus nerve function. During the day and mouth taping at night, constructive
breathing techniques are an effective mix of methods that can be used to
enhance their breathing habits both day and night.
GETTING GOOD SLEEP
We all know how important it is to have a good evening of rest. Here, I'll
give you some tips to use as part of a bedtime routine to improve the
likelihood of a safe, restful sleep night. A restful night of sleep has been
shown to enhance autonomic equilibrium through studies of heart rate
variability.
ELIMINATE BLUE LIGHT EXPOSURE IN THE EVENINGS
During the day, light wavelengths shift, and our bodies have adjusted to their
signals. When the morning sun rises, in the red/yellow wavelengths, light is
very dry. Around midday, the sun becomes much brighter and bluer. Yet
again, in the evenings, the light turns into a red/yellow shade as the sun is
setting. These are the cues our body uses to tell us the current time of day,
and which hormones and cues to secrete at different times.
Our devices all emit a blue wavelength of light, including the laptop,
Monitor, computer, and tablet. If we glance at our screens right before bed
every evening, we give a warning to our bodies that the time really is noon.
This will slow down the production of melatonin, which is an essential
hormone required to help us relax and fall asleep. Some apps now come with
blue-light filter,, but most do not.
You can:
• Trigger Night Shift on your Apple devices
• Download the Twilight app on Android devices
• Download flux or iris on your computer (Mac or Windows)
• Use blue-blocking sunglasses when you watch TV For blue-blocking
glasses, I suggest using TrueDark Twilight sunglasses…
I recommend reading a physical book or spending device-free time with
loved ones or friends instead of looking at your phone at night because social
interaction is another great way to enhance vagus nerve function.
SWITCH OFF ELECTRONICS AT NIGHT
One of the best things I've done for my wellbeing was to cancel my
subscription to cable TV. It forced me, at night, to stop watching TV. Since
then, I have taken steps to minimize computer usage in the evenings and
nights and, having done so, get considerably better sleep.
Loading your devices like a mobile phone or a laptop in a separate room,
shutting off Wi-Fi routers with an automated timer, and even placing your
devices in flight mode are perfect ways to avoid using them at night.
DON'T EAT OR DRINK TOO LATE
Bathroom breaks typically break up peaceful sleep. Whether you eat or drink
later in the evening, then you're getting your body ready to use the toilet at
night. Instead, make efforts to have dinner two hours early before you sleep,
and your last glass of water at least one hour before bedtime. The next day
your waistline and energy levels will be grateful!
LOVE YOUR ROOM
Dorming in a tidy, organized room is important to improve the quality of
your sleep and your health. You can't help but go to sleep while your
bedroom is a mess, worrying about the cleaning and organizing that needs to
be done. This emotional energy gets into your subconscious and makes your
sleep disturbed, which is essentially additional stress to your body and a
simple way to turn off the night-time parasympathetic recovery mechanism.
Get a feng shui evaluation performed on your space to ensure that it is
structured in an energy-positive manner that will help you feel better and
make you develop. Make sure you regularly clean and organize your room, as
this will have a direct impact on your mood and energy levels. To know more
about how a clean room changes the energy in your body, I suggest reading
Marie Kondo's The Life-Changing Magic of Tidying Up
SLEEPING ON YOUR SIDE
A 2008 study published in Circulation Journal by Yang et al. compared the
HRV levels of different sleep positions. The research was performed to
determine the optimal place for coronary artery disease patients relative to
those without any blockages in their coronary arteries. The researchers found
lying on your back was the worst position for HRV rates, both for patients in
testing and control while lying on either side showed substantial
improvement in HRV. Most interestingly, it has been found that sleeping on
the right side is the best for vagal modulation, particularly within the control
group.
What this basically means is that sleeping on your back, or lying on your
back for a longer period of time, would have negative effects on vagus
nervous function, whereas lying on either side (right side preferred) would
actually allow you to increase vagus nerve tone. This is because your airway
is more likely to close while you are lying on your back because your tongue
will slip backward due to the gravity pull. That's not just as convenient when
you're lying on your side. Note, an open airway is completely vital to
breathing efficiency, both in terms of breath rate and breath depth.
I suggest placing a pillow between your knees when you sleep, to make it
easier to sleep on your side. It will force you to sit on your side while you're
sleeping, and won't let you sleep on your back.

COLD EXPOSURE
Did you ever leap into a lake or pool, only to find that the water is frigid and
freezes you to your core? Your teeth start chattering, and your body starts
shivering uncontrollably. The wind, too, is totally out of balance. You take
very shallow breaths, so the diaphragm can't relax sufficiently to calm down
and breathe deeply.
As you can imagine, this scenario is perfect to trigger your sympathetic
nervous system and the response to fight or flight. In the short term, your
body is fighting to survive, and that has an immediate effect on how your
body responds. Your breath is quick and heavy, your heart rate rises, and
during this time, your body does not wish to digest optimally. All short-term
effort is intended for survival.
What you would be shocked to hear is that this, in fact, has the incredible
long-term effect of stimulating the parasympathetic nervous system.
Continuous acute cold or cryotherapy treatment helps you to control your
intake, which has an overall beneficial effect on the activation of the vagus
and major anti-inflammatory effects in the body.
Periodic exposure to cold is one of the strongest and simplest ways to restore
a damaged vagus nerve and repair it. The best way to incorporate this into
your life is to introduce cold exposure to your showers. One great advice I
give to all of my patients is to take a regular shower, then turn the
temperature down to the coldest possible at the end of the shower, and let it
hit you on the head and back of your neck for the last minute of your shower.
This will be surprising to your body first, which will change the way you
breathe. During this time, your goal is to work to regulate your breath and
take as many deep belly breaths as possible. If you can train your body to
breathe through the cold, the vagus nerve can become very powerful, and the
body will have a parasympathetic nervous system and vagus nerve
functioning optimally. As this minute gets easier, you can add one or two
minutes of cold exposure every week before you spend your whole shower in
ice-cold water, and there's a big smile on your face!
Cryotherapy is an advanced and validated technique which is used by the
parasympathetic nervous system to help alleviate inflammation and enable
healing. During each game or event, the vast majority of the professional
athletes, as well as celebrities like Tony Robbins, use cryotherapy. Mr.
Robbins swears for his own health and considers it to have great healing
effects.
For its incredible healing benefits, even Wim Hof, the founder of the Wim
Hof process, uses cold exposure in this process. He is known as the Iceman,
as he frequently participates with his clients in ice baths and teaches about the
benefits of cold exposure. If you feel that cold showers have become
repetitive and too quick, consider going out in just a pair of shorts and boots
for a hike on a mountainside. A search for Wim on a Google picture would
show him doing just that.

HUMMING OR CHANTING
Relaxing and using the voluntary muscles that signal is another way to
activate the vagus nerve. Through stimulating these muscles, you activate the
centers of the brainstem that transmit signals through the vagus-not just the
centers of muscle regulation, but also all the others around it.
You can activate the laryngeal muscles by humming and chanting, which gets
signals directly from the VN's superior and recurrent laryngeal branches.
They allow tightening and loosening of our vocal cords based on muscle
tension, thereby giving us a pitch level in our voices. When we practice deep
humming in our throat, we activate and vibrate these muscles and stimulate
the vagus to send out these signals.
You may be aware of the sacred Hindu syllable "om" that is used when
recited loudly to create a deep vibration in the throat. The "om" vibration,
which is said to vibrate at the God's resonance point, has a deep spiritual
connection in Hindu practice. Simple terms such as Amin, Ameen, and Amen
are used in many cultures, but they all seem to mean the word of god.
Vibrating at this frequency in the vagus nerve by chanting the word
effectively activates the throat and vocal cord laryngeal muscles, facilitating
activation of the VN motor fibers. When performed long enough and with
adequate energy, it can be an effective method of activating the other nerve
signaling components. It helps us to regulate our breath, slow our thoughts,
and concentrate ourselves to the point of intense deep relaxation, which has
been shown to enhance the body's rate of digestion, which inflammation. This
can be a perfect way to calm down, sync with the world, and stimulate vagus
nerve development in the digestive tract and other visceral organs like
humming or chanting the word "Om" before a meal. Practicing "om" on
certain occasions, like after a traumatic event, is a helpful resource after this
stressful event in reducing levels of stress and sympathetic activation.
There are other words to hum or chant that will effectively activate these
muscles and enhance the signaling of the vagus nerve, but "om" is one that I
have found to be particularly successful as the activation of the muscles of
the throat is clearly noticeable during the practice.
ACTIVATING GAG REFLEX
Activation of the gag reflex is another way of relaxing the muscles innervated
by the VN in the same lines as humming and chanting. Also known as the
pharyngeal reflex, this reflex is necessary to protect us from choking, which
requires a process of nerve activation to function optimally.
When an entity we do not know reaches our mouth and hits our soft palate
(the fuzzy part at the back of the mouth's roof), a very strong sensory signal is
transmitted through the ninth cranial nerve, up to the brainstem and to the
motor portion of three different cranial nerves. The first of these nerves is the
vagus' pharyngeal branch, which immediately contracts the three pharyngeal
muscles at the back of the throat to stop the object from going deeper into the
body and becoming trapped in the airway. Often, the cranial nerve five and
the cranial nerve twelve are activated, allowing the mouth to relax and the
tongue to move the object outwards.
Activating the gag reflex voluntarily will send an immediate signal to the
vagus and other nerves to keep them signaling in a quick and optimal
manner. The best time to do so is twice a day when the teeth are being
cleaned. The toothbrush should be used to touch the sensitive palate to
activate the reflex. It is a nice, easy choice known to have a direct impact on
VN signaling. Because we have a collection of cranial nerves on each side of
our body, it's important to stimulate the soft palate on both sides to get the
full benefit of this exercise.
GARGLING
During my childhood, my father always urged me to gargle with salt water
after brushing my teeth in the morning and evening, just as he has done for
his whole life every day. He used to tell me it's good for my wellbeing–but I'd
laugh it off and make the advice plain. Curiously, he was on to something.
He's a very good septuagenarian; I should have known;
Gargling is the act of holding a drink of water in the back of your throat and
aggressively spinning it around. This involves activation of the three
pharyngeal muscles at the back of the throat, and as such, it is another way of
stimulating the vagus nerve by activating the muscle. Practicing this twice a
day after brushing your teeth is a perfect way to quickly leverage this device,
as my father will constantly remind me.
Gargling with extra vigor, to the point that the eyes start to form tears, is ideal
for better performance. It actively sends signals from its brainstem nuclei
when your vagus is firing, which causes some neighboring nuclei as they
become stronger. In this case, the superior salivary nucleus is stimulated,
which triggers the glands around your eyes to produce tear-bearing fluid. If
you gargle hard enough to make yourself cry, you do so properly and have a
great impact on your vagus nervous system.
Adding any salt to the water you use to gargle, such as Himalayan pink salt,
is a great choice too. Gargling salt water has been shown to have antibacterial
effects and may help the mouth and upper respiratory tract remove any
unwanted bacteria. The use of essential oils, including oregano oil, is another
great choice in your water, with very similar results.

YOGA AND PILATES

Yoga and Pilates are not only about exercising the body but about relaxing
the mind and controlling the heart. Both approaches achieve maximum
voluntary regulation of the body while through external stressors and
teaching you how to regulate the body.
Most yoga sessions are booked with a slow breathing exercise to the deep
abdomen. The aim is to teach you to maintain your breath pattern while
keeping your body in various positions. Every of these positions requires a
particular form of physical stressor at the body. We've learned to use heat and
humidity, which are even more engaging, to raise the degree of tension
within this exercise. Two examples of this are moksha and bikram yoga.
When we can learn to sustain a long, deep breath in the abdomen during
periods of stress, our bodies can function at far higher levels. If we train
ourselves by holding our breath to handle voluntary stressors, then we can be
taught to maintain calm and handle other stressors with considerable ease.
Pilates was built around learning to breathe properly. We have addressed this
necessity in the book a lot earlier but it is absolutely important for our
wellbeing. Unless we paradoxically relax during times of low stress, our
bodies won't be able to cope with periods of high stress.
When practiced with a focus on the body, both yoga and Pilates are great
tools to refine breathing habits, enhance inflammatory responses, and activate
the VN for optimal function.

MINDFULNESS PRACTICE
Should you take a moment to sit still, close your eyes, and concentrate your
attention before starting a task? Are you making sure you put 100 percent of
yourself into the job at hand? Do you take a moment while you're relaxing to
be thankful for your surroundings?
Exactly this is mindfulness: taking the time and making an effort to pay
attention to what you are doing and what is going on around you. Many of us
are running from task to task, or putting out fire after fire without paying
attention to what is happening around us. We are so wrapped up in our own
minds that it is put on the backburner to pay attention to one particular task
and give it our full attention; it feels like a waste of time and energy to do so.
Most health-care practitioners are guilty of this, including myself. We travel
from patient to patient or appointment to appointment, ignoring or not paying
our full attention to the fact that everyone trusts us with their health and life-
related decisions. Becoming a functional medicine doctor has helped me to
have a positive and deep effect on the lives of my patients and as such, I am
much more mindful of the importance I can provide to each of my patients.
Once I bring in my next patient, I take a few minutes to study my notes,
remove any distractions from my area and clear up activities that include
other matters. Once I do so, I take a moment to note that every patient trusts
me to help them attain their health and life goals.
Practice mindfulness involves executing each task to your full potential, with
100 percent of your attention focused on that task. It means taking in your
surroundings, being mindful of and thankful for all that has taken you
through that exact moment.
The capacity to exercise sensitivity can not occur while we are stressed out,
inflamed, and in pain. Our sympathetic nervous system has a tendency to
catch our attention and keep us from concentrating on what we do. If you're
consciously practicing mindfulness during the day, you're concentrating on
your breath and how every task at hand can be done. This changes the
balance to the parasympathetic nervous system and helps the VN to do its
function.
Approaching a task deliberately means doing one thing with complete focus
at a time and completing it before moving on to the next task. Eating
conscientiously helps you to feel satiated and not overeat. Paying attention to
relaxation helps you to feel refreshed and rejuvenated faster than you can
expect. Both of these require an active and activated vagus nerve because we
must be able to rely on it so that our bodies can relax, digest, and heal. Multi-
tasking is the exact opposite of being conscious.
Getting mindful of what I'm doing, eating, and thinking as each job approach
was the most positive improvement I've made in my life, and it's by far the
number one factor that my health outlook has become more positive. For me
and many others around me, it has been a huge needle-mover, and I'm sure it
will create significant positive changes in your life too.
THERAPY
Therapy is similar to a mindfulness exercise. It's the art of taking care of your
breath and telling your heart not to follow every thought that comes into your
mind. Our brains are built to create complex, creative linkages between our
thoughts and actions. Meditation helps us to listen to our hearts and focus on
our breath, to learn to become listeners of our thoughts and not victims of
their fluidity.
Instead of discussing the various forms of meditation, I would like to explore
its benefits. Studies of variation in heart rate have shown that meditation has
major beneficial effects on the activity of the vagus nerve, and when we
meditate, our focus turns towards our breath. There are several different
forms of meditation, but breath-focused ones are usually best for HRV rates
improvement. These include meditation on the air, meditation on loving-
kindness, vipassana, and meditation on mindfulness.
One interesting tidbit of knowledge I found through my research is that HRV
showed only progress in patients who did not self-identify as perfectionists.
Research by Azam et al. found in the International Journal of
Psychophysiology that control patients were much more likely to have
positive HRV-level improvements compared to those who self-identified as
perfectionists. Essentially, "perfectionist" has become so focused on
meditating properly or appropriately that they have been able to relax and
benefit from the practice itself. One of the most popular comments I hear
about meditation when I ask my patients is that they are "not able to do it
right." This perfectionist mentality is precisely what keeps them from
understanding the benefits. It is easier to benefit from the practice while
doing meditation without any assumptions or preconceived ideas about "the
best way" to do it.
To beginners, I suggest using audio-guided meditations found on YouTube or
by using a phone app. I recommend the 21-day meditative journey by
Headspace, Oprah Winfrey and Deepak Chopra, Relax, and Insight Timer.
For those who want input on the practice of meditation, HeartMath's Inner
Equilibrium is a fantastic resource to help you decide whether you have
reached a state of congruence calculated by a change in heart rate. Another
resource for those interested in having clear knowledge is Muse, the
headband for meditation, which tracks brainwave activity and gives you
audio feedback in real-time. These are add-on devices and should not be used
at all, but they can be a good investment for those who usually aim for
excellence.

LAUGHTER AND SOCIAL CONNECTEDNESS

Would you do it more often if you knew that more laughter would benefit
your health? The last time you've had a good bonding session with friends,
remember. Did you feel good for the next few hours? Have you slept the
night better? Have you been waking the next morning to feel great?
Repeated ongoing work shows laughter and laughter yoga to be very
successful in enhancing variation in mood and heart rate. As we laugh with
vigor and laughter, we continue to use our diaphragms and, in effect, practice
our ability to regulate our pulse rate and ensure that our breathing patterns
can be controlled. This is a vagus nerve exercise.
Having a daily occurrence of enthusiastic laughter is a fantastic and very
pleasant way to boost the vagus nerve work. I'm going to watch funny videos
or comedy shows as much as I can to feel socially connected and appreciate
the health benefits of laughter. Taking laughing yoga classes in your
neighborhood, frequently meeting with friends to share fun stories, and
putting on a comedy film are all great choices for more laughter. Social
interaction is directly associated with this because when we are in the
company of others, particularly friends and family, we are more likely to
laugh out loud. Social interaction is one of health's biggest determinants, and
could be even more important than the food you consume.
People would like to be around others. When we feel alone and isolated from
others, we will have a negative effect on our mood and health. We continue
to enjoy others ' company, and prefer to have face-to-face interactions with
real people. We appear to laugh more when we're around others, smile more
and feel more confident.
When we spend time with people we connect and share the ideals with, we
feel even better. Recently, I was able to take my family to a Living Proof
Team Retreat in Minnesota that was a wonderful experience. The stunning
natural environment and surroundings were combined with spending time
with team members sharing the same ideals I do. At Point Retreats, we were
taken care of by the team, another amazing group of people who supports
getting people back to healthy and happier lives. We were both really content
and comfortable at the end of the journey, regardless of the travel tension.
If you feel lonely, down, or just disconnected, you'll find a way to spend time
with others and communicate with people with common values. If physical
exercise is a major benefit, enter a gym or take part in a yoga class with
colleagues. If contact is a significant value to you, join a community of
toastmasters, and practice your public speaking skills with friendly, like-
minded people. When you enjoy quality time with others, then go to a movie
or a nice meal to have a great time and converse. On earth, there are 7 billion
people and countless events and interactions that allow you to communicate
with those people.\
It's believed we laugh less as we age, but the healthiest people I know make
more of a point of laughing. And social engagement is a common trend in the
blue zones, the areas around the world with the highest survival rates (with
many people living past 100 while still being physically active.
So get out and enjoy social activities with those around you, meet new
people, share fun stories, and laugh as loudly and as much as possible.

LISTENING TO MUSIC
After listening to some wonderful music and singing along, don't you feel
very good? This is because the body really feels comfortable throughout and
after this period, and is able to conduct recovery processes. It's the same
reason why we enjoy belting our favorite songs into the lyrics while sitting in
our cars or stuck in traffic.
A 2010 research by Chuang et al. found that cancer patients who took part in
a 2-hour music therapy session that included singing, listening, studying, and
performing music reported substantial improvements in measures of heart
rate variability, and therefore in vagus nerve and parasympathetic nerve
activities. In 2014 another study by Lin et al. used HRV to show that the
music of Mozart would enhance the function of the parasympathetic nerve.
Most of this study was conducted with children who were diagnosed with
epilepsy, a severe seizure condition. Listening to the music of Mozart,
particularly the "K.448" sonata for two pianos by Mozart, showed a decrease
in recurrence of seizures and changes in the brain.
Next time you sit in traffic and feel anxious that you are late for a meeting or
a job, put on some good music and let your body shift and sing along with it.
You will naturally feel more confident and less anxious, and at the same time
you will always be getting to your meeting. Play Mozart in the background if
you are at home and sound out of it, and remember how you sound
afterwards.
Art has the power of healing. It has the power to take people for a few hours
off of themselves.

WISE DIETARY CHOICES

As the study gradually becomes clearer, we are finding that there are foods
that can have a detrimental effect on our cellular and digestive health and
which have a greater likelihood of growing rates of inflammation. Many of
these options are heavily processed products; products tainted with
antibiotics, hormones, herbicides, and pesticides; and genetically modified
foods. Avoiding these foods is important in reducing the possibility of
damage to each of our cells ' gut lining, liver detoxification system, and
wellbeing.
I promote organic, locally grown fruits and vegetables when selecting
balanced and smart foods; lean, free-range chickens and eggs; lean, grass-fed,
and finished beef; non-GMO grains such as rice and quinoa; and organic nuts
and seeds. For a majority of people, the best way to start is a fresh, clean, and
lean diet made from healthy fats and minimally processed food. I recommend
reading Food: What the Heck Would I Eat To learn more about dietary
options? Via Dr Mark Hyman. Follow his four-week plan, and re-introduce
one meal at a time. Note, the diet needs to be adapted to your needs and
desires. Vegan, autoimmune paleo, paleo, and ketogenic diets are all
beneficial, but you should have a diet that fits your needs. Note green, clean,
and lean while shopping at the grocery store or farmer's market, my personal
three rules are mine.
Foods that contain nutrients helpful to the development of ACh are important
when looking specifically to increase vagus nerve function. Acetylcholine is
the main neurotransmitter used by VN, and low levels may lead to nerve
function and signaling in the suboptimal vagus. Nutrients needed to allow the
development of ACh are high in choline, such as egg yolks; high-quality
cooked organ meats such as beef, chicken, and turkey livers; and soy lecithin,
a common food additive.
Another effective tool for improving vagus nerve activity is to give it a
break–literally, let the vagus nerve take a while off. Intermittent fasting and
time-limited feeding are important methods for increasing flexibility in the
heart rate. I personally use this method to regulate blood sugar, increase
energy levels, and reduce stress on my body. Intermittent fasting has been
shown to increase HRV, which is a sign of maximizing vagus nerve function
and increasing health in the long term.
Limit food consumption to a six-to eight-hour period when you're awake to
do intermittent fasting or time-restricted feeding. For example, you can
restrict calorie intake at breakfast time, thus reducing the amount of sugar
contained in the blood early in the day, and have your first lunch meal.
Personally, I eat two meals a day, between noon and 8:00 pm, while taking an
amino acid powder a morning to ensure my cells have the resources they
need to function optimally. Join my online Energy Boost Challenge at
www.energyboostchallenge.com to learn more about this activity and try it
out yourself for a 2-week span.

DAILY MOVEMENT AND EXERCISE

Our bodies are designed to move. Muscles are some of the body's most
essential and neglected muscles, and muscle cells are the best to help us
regulate the levels of our blood sugar and body fat–if we use them. The
problem is that most of us are sitting and avoiding movement every day for a
very long time, and then sitting in the car, sitting on the sofa, continuing this
constant lack of movement.
Practicing some degree of movement, ideally one that helps raise the heart
rate for a short period of time by increasing body stress levels, helps to boost
parasympathetic nerve function. There are occasions that both the
sympathetic and parasympathetic processes should be triggered, and one of
those conditions is rehabilitation following exercise. Upon healing, we
optimize our breathing pattern, which enhances feedback to the airway's
muscles to improve patentability, trains the heart to become stronger, and
pumps out more blood with each pump, and helps us to change back to a
normal parasympathetic state.
Moving your muscles and forcing the body to do activities that stress you out
on a regular basis will teach the body how to heal quicker from the stress
while also helping you regulate energy levels and sources of macronutrient
fuel. Using the muscles to make stuff happen on your body, preferably
outdoors.
SUNLIGHT EXPOSURE
Day-long exposure to sunlight is directly linked to your health. Our bodies
are genetically designed to function according to the amount and form of
sunlight that falls through our eyes and skin. This has a strong impact on the
way we function at a cellular level. When we spend a whole day indoors with
minimal access to true sunlight under artificial lighting, we are depriving our
cells of optimal signaling and work.
During daytime, exposure is specifically correlated with increased levels of
HRV. Throughout sunrise and sunset, our eyes and skin tend to absorb
signals from red, infrared, and yellow wavelengths, while at mid-day, they
tend blue, green, violet, and ultraviolet light. Sun exposure will do so
naturally, but at least not yet will our offices, vehicles, and homes. Around
the time of this writing, several businesses are improving the Circadian
lighting technology.
Since sunlight is directly linked to HRV rates, it is highly recommended that
you get outside and get direct sunlight every day on your skin. An even better
choice is to do so at many different times of the day. Within 30 minutes of
dawn, two or three times during the day and within 30 minutes of sunset, the
best opportunities to get outside are. Even still, spend the entire day outside
whenever possible. When the body feels the sunrise and is pre-conditioned to
the UV light that we feel during the day, you are much less likely to burn the
skin during the day.

SUPPLEMENTATION
Due to the lack of nutrient density in our diets and the reduction of our
microbiome diversity in our ecosystems, supplementation is a good way to
ensure that our cells get the right micronutrients and signals that will enable
them to function optimally. Contrary to previous belief, supplements aren't a
waste of time, as long as the right person takes them for the right cause. We
can decide the best supplements for each person to achieve their optimal
cellular function using functional laboratory testing. However, there are
certain essential nutrients and supplements for the signaling that can benefit
us all. Remember that this is for general guidance. You should talk to your
primary health care provider before beginning or stopping any prescription or
approved drugs or supplements.

PROBIOTICS
Antibiotic use, C-sections, and low nutrient content diets have led us to
reduced bacterial diversity and low levels of healthy bacteria in our intestines.
Testing to confirm which bacterial species are present is the best option, but
most of us would need to use probiotics to help our gut and skin microbiome.
Probiotics are naturally occurring bacteria. We will help increase the bacterial
diversity and establish healthy bacterial colonies when ingested. They are
distinct from prebiotics, which is typically extracted from fiber and serve as
the bacteria's food for us to produce vitamins and minerals.
I prefer spore-based, naturally developed bacterial species such as Bacillus,
which are naturally developed in soil when selecting a probiotic. Such
probiotics fill in the voids left when other bacteria die. Probiotics that need to
be cooled tend to have a very low absorption rate (5 to 10 per cent) relative to
spore-based probiotics and those that need not be cooled. The question I
wonder about probiotics that need to be refrigerated is that if the bacteria
can't withstand room temperature, how can they get past the stomach acid and
survive in our higher body temperature?
For most patients on a maintenance protocol, MegaSporeBiotic is my
preferred probiotic alternative. It has a very high rate of absorption, it does
not need to be refrigerated, and it contains Bacillus species that can help fill
the voids left by several different forms of lacking bacterial organisms, not
just Lactobacillus and Bifidobacteria, which are the key organisms protected
by most probiotics.

OMEGA-3 FATTY ACIDS

Our Regular American diet and diets with low nutrient density do not contain
high-quality omega-3 fatty acids. Sometimes referred to as fish oils, they are
most often obtained from fish, but may also come from certain plant sources,
which are the preferred vegan source.
The problem with most ingestible omega-3 oils is that they are produced
chemically from natural sources, and this manufacturing reduces the potency
of these sources. The natural form includes triglycerides, while ethyl esters
are found in the refined form. Ethyl esters tend to taste and smell much more
catchy than triglycerides.
I strongly recommend opting for the triglyceride form when selecting a high-
quality source of omega-3 fatty acids because it is safe and contains a high
amount of EPA and DHA, both of which are essential for brain function and
anti-inflammatory effects in the body. EPA and DHA enhance the function of
the nerves, including VN function, as they are essential for nerve myelination
and have anti-inflammatory effects. Also recently, supplementation of
omega-3 fatty acids has been shown to increase variability in the heart rate in
obese children. I personally use the Ortho Molecular Products and Health
Interface capsules, both for my patients and my colleagues.

5-HTP FOR SEROTONIN

This section addresses problems related to low mood and depression.
Unfortunately, depression and mental health problems are very prevalent in
North America today, and research has shown that antidepressant
medications can potentially cause more of a problem. A long-term research
conducted in 2014 by Regan et al. found that there was a decreased HRV in
patients with depression, and that these rates are potentially increased by anti-
depressant drugs that aim to boost serotonin levels.
The serotonin receptor is called 5-HTP. It can be used as an important
supplement allowing the body to build up its own serotonin. Many depression
cases are due to serotonin deficiency, and organic acid functional testing,
which I use for virtually every patient entering my office, will actually tell
our patients whether they have too much serotonin and use it very easily, or
whether they are running low in their output.
One thing to note is that the vast majority of serotonin development is driven
by the intestinal microbiome. A healthy microbiome generates a decent
amount of serotonin, which makes a positive attitude whereas an unbalanced
microbiome does the reverse, contributing to an increased risk of mental
health issues.

COFFEE ENEMAS
The enemas can be highly effective in more serious cases of bowel motility
problems, particularly when people are chronically constipated and unable to
clear their bowels for quite some time. A good coffee enema is a nice and
easy choice with an exceptionally high degree of efficacy. In the book Why
Isn’t My Brain Working? Dr. Datis Kharrazian explains how the caffeine
present in coffee highly activates the nicotinic ACh receptors, which are the
same receptors that the vagus influences by releasing acetylcholine. Caffeine
activates these receptors in the stomach, triggering an involuntary impulse
during a bowel movement to empty the intestines.
To use this method effectively to re-train the vagus nerve, you need to inhibit
this impulse for as long as possible. Through resisting the desire to go, you
potentially cause an axis to fire in your brain (the frontopontine vagal enteric
axis), effectively causing the vagus and brain to become highly active and to
learn to reactivate these gut motility nerves. When you do so consistently
over time, a coffee enema will retrain the vagus nerve and be able to expel
stools without the need for external help.
When you have trouble with chronic constipation and inadequate liver
detoxification, then this cycle is an excellent method to help you clear the
bowels and more efficiently get the toxins out of your body. You'll actually
be training the VN to learn how to fire and influence the nerves that regulate
gut motility by doing so correctly and resisting the urge to void for as long as
possible.
 CHAPTER 7

PASSIVE METHODS TO ACTIVATE THE

VAGUS NERVE
Among all the aggressive activities you can do on your own, there are passive
therapies that can have significant effects on vagus nerve activation. Several
of these include using other devices or visiting a health care facility while
some can be performed in your own home comfort. Until starting some kind
of treatment, remember to explore these choices with your primary health
care provider.
AURICULAR ACUPUNCTURE
Acupuncture is an important method of treatment for many disorders, and
with my patients, as a hands-on chiropractor, I have seen the amazing effects
firsthand using it. If you note, one of the four types of signals mediated by
vagus is sensation to different parts of the outer ear, or auricle: the entire
concha, the helix crus, and the tragus. As such, stimulation of these specific
regions can have effects that can activate the vagus nerve function. The vagus
nerve receives solely sensory input from the central and anterior portions of
the ear via its auricular branch. We will increase the flow of information in
the auricular branch of VN by using acupuncture, and thus increase the
activation of VN.
A substantial and increasing body of research indicates that in many patients
with depression, anxiety, epilepsy, LPS-induced inflammation, tinnitus, and
highly active pain receptors, acupuncture and transcutaneous vagus nerve
stimulation via the auricular branch of the VN yield beneficial results. The
best thing about this method of treatment is that it is effective without
invasive action.
There is also a growing development within the health care community
focused on vagus nerve activation by electrical stimulation. This is achieved
by implanting an electrical stimulator on the vagus nerve itself, surgically.
Acupuncture is considerably safer than this invasive procedure and just as
effective. In addition, the exact same neural pathways include auricular
acupuncture and implanted vagus nerve stimulation devices. I will actually
prefer acupuncture at any moment, provided the opportunity.

MASSAGE THERAPY AND REFLEXOLOGY

Massage therapy is an ideal resource for us to relax. I actually move slowly
right after a successful massage, breathe deeply, and see the world in a more
optimistic light. If the doctor hits some very tender spots, the majority of
people feel comfortable and refreshed after a massage. This experience may
be the epitome of parasympathetic activation and sympathetic disabling.
Not unexpectedly, several different massage techniques have been linked to
increased rates of HRV or enhanced vagal tone like Chinese head massage;
traditional Thai massage of the shoulder, neck, and head; conventional back
massage; and even self-massage.
I always recommend attempting reflexology for several of my patients who
have difficulty getting comfortable. I had been open to the possibilities since
my mom began to practice reflexology, and was the first to volunteer as a
patient as she was studying. I would fall asleep each time she was operating
on my feet, even as a teenager. For this reason, I wasn't shocked when I
found a research paper showing patients treated with foot reflexology
reported significantly improved rates of HRV and lower levels of blood
pressure 30 and 60 minutes after treatment.
Passive treatments such as massage therapy and reflexology may have
tremendous beneficial effects on our health if they help us relax and improve
the activity of the vagus nerve. This is yet another perfect excuse to have
massages scheduled daily!

VISCERAL MANIPULATION
Visceral manipulation (VM) is a technique which is less common but which
is very successful when done correctly. Usually performed by osteopaths,
chiropractors, naturopaths, and other health care practitioners, VM is the
gentle physical stimulation of the abdomen's organs, thereby increasing the
supply of blood to areas that do not function best. When learnt right, patients
will use this feedback device on their own.
As we know, all abdominal organs including the liver, gallbladder, pancreas,
kidneys, spleen, uterus, small intestine, and ascending and transverse portions
of the large intestine are innervated by the vagus nerve. For the VN to
influence these organs and communicate organ activity to the brain, optimum
functioning of the organs is essential. Within these organs, physical
constraints can build up and can only be altered by physical coercion and
mobilization. Improving the blood flow to these organs can have major
beneficial organ health outcomes and allow the VN to send out optimal
function-related signals.
Gently applied hands-on therapy is used by visceral manipulation
practitioners to identify places of altered or reduced movement within the
viscera and remove constraints within these visceral organs. The procedure
requires a gentle squeezing, relaxation, or soft tissue elongation. Finding a
licensed visceral manipulation therapist in your area might be a good idea,
especially for those with detoxification dysfunction or liver, gallbladder, or
kidney pain.

CHIROPRACTIC TREATMENT
Mechanical pain in the neck and back is common everywhere. In the last 20
years, they have become even more common as our occupations and
professions have become much more sedentary, and the majority of them
allow us to sit for hours on end in front of a screen. As a chiropractor, as a
result of sitting in this position for several hours each day, I treated thousands
of patients struggling with pain in their neck and back.
The muscles surrounding them can become very rigid and weak when joints
are not worked across their full range for a long period of time. The effect is
that the joints will become slightly misaligned, leading to discomfort.
Mechanical joint pain caused by lack of movement is more common than
pain induced by joint overuse. In my research, I found it totally true that if
you don't use it, you lose it–a joint feature, that is. A 2015 study in the
Journal of Chiropractic Medicine showed that a chiropractor's stimulation of
the spinal cord in patients with neck pain resulted in substantial positive
improvements in blood pressure and heart rate variability, dramatically
enhancing VN performance. Research published in the Journal of
Psychological and Physiological Therapeutics in 2009 yielded similar
promising results for lower back pain patients. Both of these researchers
found that pain relief allowed patients to breathe more slowly and enhance
their vagus nerve function, and that chiropractic manipulation had a
beneficial effect on the mechanical function of patients. Especially when one
is in pain, chiropractic treatment can be a very successful therapy tool and
can greatly support the VN and parasympathetic operation.

ELECTRICAL STIMULATION
Scientists have performed experiments over the last hundred or so years to
learn about the effects of the vagus nerve. One technique involved
stimulating the VN on laboratory animals with the help of electrical
stimulators. In addition to learning about the value of the VN itself,
researchers gradually found that they were able to improve its functions by
electrically stimulating the vagus nerve.
Experiments were performed in the 1980s and early 1990s to demonstrate
that vagus stimulation in the neck was effective in reducing seizure activity in
dogs. This work resulted in dedicated clinical trials which developed devices
for vagus nerve stimulation (VNS) that could be implanted into the neck. The
FDA approved these devices for the treatment of epilepsy in 1997, and for
the treatment of severe, treatment-resistant depression in 2005. Regarding
numerous medical problems, including insomnia, bipolar disorder, treatment-
resistant anxiety disorders, Alzheimer's disease, and obesity, researchers and
companies have been developing and enhancing tools to electrically stimulate
the VN since. The most commonly used clinically electrical VNS system
today is the Cyberonics NCP System, which is inserted during an outpatient
procedure on the left vagus nerve. This unit is used for treating patients with
extreme depression and/or epilepsy resistant to the medication.
Right-side VNS is useful in animal models of epilepsy and seizures, but
strong effects on depressive symptoms are not established. Preliminary
clinical trials are promising and have shown positive results, and several
companies have already begun to develop vagus nerve stimulation devices
that can be used for specific conditions. BioControl Medical's CardioFit
device uses right-side VNS to trigger efferent fibers and aid in heart failure
care, whereas BioControl Medical's FitNeSS device is programmed to enable
afferent fibers, thus helping to reduce the side effects of electrical vagal
stimulation.
Typical surgical risks associated with this operation include infection,
discomfort, scarring, swallowing problems, and paralysis of the vocal cord.
Side effects of implanted electrical stimulators include speech changes,
heaviness, sore throat, cough, headache, chest pain, breathing difficulties
(especially during exercise), trouble swallowing, abdominal pain, nausea,
skin tingling, insomnia, and bradycardia (heart rate slowing). Though many
of these may be temporary, they may be serious and may last forever.
There are other electrical stimulation devices which do not need to be
implanted, but they have inconsistent results and are only licensed at this
stage for some conditions. Cerbomed's NEMOS system is a transcutaneous
VNS unit, applied to the vagus-innervated part of the body. Currently, it has
been approved for epilepsy and depression treatment in Europe. In Europe,
gammaCore system from the US-based company electroCore has been given
approval for acute treatment of headaches in clusters, migraines, and overuse
of headaches by medicine. The gammaCore is a compact handheld device
with two flat contact surfaces for stimulation that are spread over the vagus
nerve to the neckside. Larger trials for treating other disorders are ongoing.
As exciting as electrical vagus nerve stimulation is, I would consider using
routine exercises and developing beneficial behaviors before seeking out
external devices such as electrical stimulators. When you can have a positive
effect on your vagus nerve function using the previously mentioned activities,
I believe the symptoms will improve significantly with no unnecessary
complications and costs.
 PART 3

CHAPTER 8

WHAT COULD GO WRONG

Having gone through all the numerous and significantly important tasks
performed by the vagus nerve, it is easy to see that if the VN function is not
optimal, your health may suffer.
Imagine the charging wire to your mobile phone for a moment. If the wire
has one of three separate issues, your mobile phone would not receive ample
power from the outlet you've plugged into it. Such three problems
encompass:
1. The plug is not working properly in the wall socket,
2. Wire not successfully connected to your mobile phone's charging port, and
3. The wire itself is bent, frayed or twisted.
Each of these three problems will result in your mobile phone being charged
slower than average, and a large degree of irritation.
The vagus nerve has similar damage points; however, defective signaling
results in the nerve have far more damaging and far-reaching consequences,
which can result in the need for modern medicine to be diagnosed and
treated. Hold in mind as we go through Part 3 that in a vast majority of cases,
the vagus nerve tone can be strengthened and fixated. There is hope if you or
a loved one suffer the consequences of relaying dysfunctional knowledge.
Throughout the following chapters, we'll go through the most common
pathways leading to vagus nerve dysfunction and explore how such
dysfunctions may manifest as symptoms.
There are various issues that could go wrong in the vagus, but we'll
concentrate on: irregular breathing, heart rate dysfunction, chronic stress, and
lack of social contact.
DYSFUNCTIONAL BREATHING
Dysfunctional breathing is the main and most common cause of
dysfunctional signaling in the vagus nerve.
Immediately after we leave the womb of our mother, it's our duty to take our
first breath of air. Although our hearts are already beating in the womb, and
thanks to our mothers' help, our digestive tracts are still functioning.
Breathing is the first job we get when we are born, and it's the only thing our
small, brand-new bodies have to do to survive outside the warm, cozy world
we grew up in and built for about 40 weeks.
The doctor or midwife will help us with this initiative by clearing our
airways, allowing our diaphragm muscle to move freely into the lungs, and to
contract and relax. They assist this function by removing fluid which can
obstruct the pathway. This fluid normally reaches the airways and lungs very
late in our fetal development as we take some practical breaths. The
diaphragm must learn to contract and relax, as it is the required controlling
mechanism for breathing.
The vagus nerve affects the diaphragm without impact. It is operated by the
phrenic nerve that originates in the neck (from cervical spine level 3) and
runs adjacent to the vagus into the thorax and through the lungs and heart
before entering the most critical muscle for breathing function.
When our airways have been cleared, the first breathtaking activity begins.
Our diaphragm contracts and creates a vacuum effect in our thorax, causing
our lungs to expand and take in the oxygen-containing external air, among
other gases. The vagus nerve signals our lungs extending to the brainstem,
and we know that our mother no longer offers physical support for the
oxygen we need. The job has been ours for the rest of our lives now. Then
our diaphragm relaxes and forces the air out of the lungs and through the
trachea, then out of our mouth and nose. The breathing cycle has started.
As a baby, we know the automatic and right way to breathe. Take a moment
to watch how they breathe every time you're around a happy child or toddler.
What you'll find is that their diaphragm will contract in order for them to take
a breath in, and in doing so, they must actually expand their belly in the
process. Diaphragmatic breathing is the mechanism whereby this main
muscle is used for breathing rather than peripheral muscles.
Take a moment, place one hand on your belly and one hand on your shoulder,
close your eyes, and breathe deeply.
I'm serious; check to see if you breathe correctly, right now!
Did your belly expand when you took this deep breath, or did you lift your
shoulders to match your lung expansion?
When we grow and evolve through adolescence and enter our teen years,
with the utmost respect and desire for emulation, we watch those around us.
We want to look like those around us and behave like them; we prefer to
imitate the mannerisms of those we look up to. Such people are always in the
media and are introduced to us in a shallow way. Crazed culture in the North
American social media, how you look is perceived to be one of the most
significant aspects about who you are. It is an inconvenient fact, but a
significant observation that has come across many others and I. In our
childhood and teenage lives, we are told that thinner is healthier and that our
belly size represents who we are.
If we start to understand these feelings and equate them to how we look and
sound as adults, we are actually modifying our breathing habits. Our
abdomen's constant expansion and contraction are not considered desirable,
so we learn to breathe in another way. We start breathing using our accessory
muscles–the backup muscles that are more critical and efficient in stressful
situations. Using the muscles of the spine, shoulders and upper, middle, and
lower back, as well as the anterior chest muscles, we begin to regulate the
thorax expansion and the vacuum development.
Here's an interesting thought to ponder: Do you really train the muscle to do
the job while you are exercising a different form of muscle in your body? If I
want to be able to lift weight using the brachii biceps muscle in my arms and
do bicep curls with weights over and over again, am I training the bicep
muscles, or am I training the nerve to transmit signals to the bicep?
Through work, we now recognize that repeated movements and muscle
exercise actually have more effect on the signaling nerves than on the muscle
itself. The nerves regulate the signaling to the muscle, and as we practice, we
actually train the nerve to send out signals to the muscle faster and more
effectively than before. The muscle expands as blood flow to the region often
increases as the usage of the muscle increases. This blood contains oxygen
and macronutrients such as amino acids and it helps eliminate any waste
products.
Where you send flow is where you send function.
--Sachin Patel
The key thing to take away from this is that we can train nerves to signal and
develop their function more effectively. In the same way, if we do not train a
specific type of muscle or nerve, the nerve's function becomes unstable and
sluggish. This less effective nerve signaling is the first stage of a complex
combination of nerve and muscle dysfunction and nerve dysfunction.
As for breathing, for years, we have been teaching ourselves excessively to
breathe inappropriately and inefficiently for the shallow reasons that have
been subconsciously rooted in most of us from the beginning of our lives.
This has contributed to several nervous problems. The phrenic nerve was not
learned to breathe properly, because we usually do not use our diaphragms to
breathe through our bellies. In the same way, as we are not completely
expanding and causing successful vacuum results, the lungs are not
adequately expanding and the signals of the vagus nerve as such.
Signalisation of the vagus nerve is less effective as our breathing is less
effective.
Breathing is the first act of life, and the last. Our very life depends on
it. Since we cannot live without breathing it is tragically deplorable to
contemplate the millions and millions who have never mastered the art
of correct breathing.
--Joseph Pilates
Breathing right is one of the easiest and safest things to do for your
wellbeing. So many different methods, practices, and trainings are at the core
of proper breathing techniques. In the next segment, we will address several
of these, which will concentrate on improving each of those dysfunctions.
The failure to regulate stress rates is another symptom of incorrect breathing
patterns. Those with mental and physical stressors that feel chronically
stressed also have very bad breathing patterns. Pause and take a moment to
consider your breathing, the next time, you get riled up or find yourself in an
disagreement or heated conversation. We typically take short and shallow
breaths in these situations which trigger our response to fight or flight.
Pausing and taking deep breaths allows us to become more rational and calm,
which very easily allows us to get a good outcome. Those with poor vagal
tone appear not to be able to regulate their rage, and they are always quick to
lash out and lift their voice, altering their breathing habits against such
shallower and faster breaths.

DYSFUNCTIONAL AIRWAYS
Can you remember the last time you've had a stuffy nose? Remember trying
to breathe in through your nose and feel terrible? Your strength was weak at
the same time, and you probably had a bit of a sore throat or didn't feel great
on the whole. If your airways are not clear, then deep and complete breathing
can be very difficult. For anyone living with a deviated septum, chronic
adenoid inflammation, and post-nasal drip, this can be a constant problem.
Both of these problems will lead to the airways failing to operate optimally.
The problem of defective breathing associates defective airways. I am
speaking explicitly of the nasal passage, the pharynx, the larynx, and the
trachea when I speak about airways–all of which are known as the upper
respiratory tract. There are a few different insults and problems that can have
a negative effect on our airways, and in this segment, I will address could.
The first is attitude which is unstable.
We exist in the era of smartphones and laptops. We sit at our desks and gaze
hours on end at our computer screens, then take breaks from our machines to
look down on our smartphones. We all, including myself, are guilty of this.
We spend hours in a weak mechanical pose, contributing to back and neck
pain and then keeping our cellphones under our nose. For the most part, we
all know that postural issues lead to the spine's neck, back, and shoulder pain
and mechanical weakness, but it is easy to forget the difficulties it creates
with the airways and the ability to breathe properly.
Here's another check that you can do right now. I want to see you sitting in a
slouched spot. You did so, did you? Well, fine.
Now, by stretching your chest, I want you to try and take a deep breath in,
respite with your diaphragm.
Was it simple or difficult? Most people find it harder to take a deep breath in
a slouched posture, and probably even painful. The explanation for this is that
when we slouch, the middle portion of the spine (the thoracic spine) lies in a
flexed forward position. To optimally expand and contract, the diaphragm
requires a less flexed thoracic spine position and an extended lumbar spine
position. In a slouched pose, breathing using the accessory muscles is usually
much easier and less painful.
Another problem when we look down on our desktop screens (and even
farther down on our cellphones) is that for longer periods of time our necks
appear to be bent in a flexed posture. It in turn causes us to close our airways,
so that the pharynx and larynx muscles can not stay strong and allow the
airway to remain as open as possible.
At another point, this portion of the airway is also particularly vulnerable to
weak muscles: during the night, when we're asleep. Snoring and sleeping
apnea are significant health issues that are much more common than most
people would imagine. I was one of the millions of people suffering from
sleep apnea during my days as an overweight youth and in my 20s. And my
illness went undiagnosed, like so many other sufferers.
During sleep, sleep apnea is most frequently caused by some sort of
obstruction to the upper respiratory tract. Vagus nerve dysfunction has been
the most common cause of this problem I've encountered in my work.
Weakness in the pharynx's sound and intensity causes the tongue to fall into
the back of the mouth. This phenomenon appears to affect people who
breathe mainly through their ears, rather than their nose. I was one of those
people, and I tried to change the habit and educated myself.
We are supposed to breathe through our nose; mouth is just a backup plan.
Our noses, after all, have hairs to clean the air, and our mouths have teeth to
chew the food. Speak to every dentist and they will inform you that patients
who breathe from their mouths certainly have a far greater oral health
problem than nose breathers. Breathing by the mouth dries the saliva out and
can be considered dangerous. A dry mouth causes bacteria in our saliva to
develop uncontrolled by antibodies, leading to bad breath (halitosis), tooth
decay, and cavities. This problem is also often caused by persistent
obstruction to the nasal passage. A lack of ventilation through the nasal
passage contributes to recurrent sinus and postnasal drip infections.
It is possible to teach yourself to breathe through your nose and will be
addressed in greater detail in the next section. Training the pharynx and
larynx muscles is also necessary to improve muscle tone and vagal tone.

MONOTONE VOICE
I recently came to my office a patient suffering from a lot of emotional stress.
She had suffered a rough breakup and had some problems with her parents at
home. She had been struggling with an irritable bowel syndrome diagnosis
and had been given several medications to help relieve these symptoms, but
with only few progress to emerge from them. One of the signs I found during
our initial evaluation was that she was not completely capable of through and
diminishing her voice's pitch and sound. Her voice was completely
monotonous.
Monotony is a sign of poor control over the laryngeal muscles which
manages the vocal cord tension levels. When someone has a monotonous
voice, it's a sign that signals don't move through the vagus ' motor part
efficiently, so the muscles don't get enough signaling to contract, lengthen,
relax or stretch the vocal cords. This contributes to very minor shifts in cord
stress, and hence inability to regulate pitch or voice tone.
I immediately prescribed some unique vagus nerve toning exercises for this
patient, and she was able to make major changes in her health and the sound
of her voice within just two months. She had more control over her speech
and had increased rates of contact with her mother. If you listen carefully to
yourself or others around you, these little signals can be picked up which will
guide you in the right direction.

DYSFUNCTIONAL HEART RATE

It is claimed that the normal heart rate resting in humans is between 60 and
100 beats per minute. The calmer and more composed you are, the lower
your heart rate will be, and the more nervous you are, the faster your heart
will beat. Electric impulses from the vagus nerve and sympathetic nerves
determine a heart rate increase. The lower the heart rate, the stronger the
nerve in your vagus. Ironically, there are findings that show that one's
lifespan is inversely associated with resting heart rate, and the longer you
live, the lower your heart rate. From this, we can extrapolate that better tone
and function of the vagus nerve is correlated with lower heart rate and thus a
longer natural life expectancy.
If a vehicle spins out of control on an icy lane, the driver instantly feels
anxious and enters the state of fight or flight. The sympathetic nerves
automatically fire and the vagus is shut down. The signals from the
sympathetic nerves speed up the heart rate by signaling that the arms and leg
muscles need even more oxygenated blood to power the steering wheel and
move the car's brakes.
When the car has arrived at a safe stop, the sympathetic nerves gradually stop
firing and the vagus will turn on back. Vagus has the effect of slowing the
heart rate using soothing, rhythmic electrical signaling.
One sign of a defective vagus nerve is the failure to normalize the heart rate
rapidly after a traumatic event of this kind. The amount of time a person
spends after a traumatic event with a high heart rate and slow respiration is a
clear sign of vagus nerve activity. Someone who can relax their nerves easily
and slow their heart rate has a very good vagus nerve, while anyone who
takes longer to get back to their resting rate is possibly suffering from
dysfunctional nerve tone of the vagus. How well do you work under the
pressure of this kind of high-stress situation? Can you remain very calm and
reasonable when faced with a situation like this?
The opposite of this problem can also occur as "an uncontrolled, overactive
vagus." Vasovagal syncope is a big concern due to underactive sympathetic
nerves and a hyperactive nerve of the vagus. Syncope is the psychological
term for fainting. The sympathetic nervous system tends to increase blood
pressure and heart rate while the parasympathetic nerves work on the heart to
regulate heart rate and lower blood pressure. If the sympathetic nerves are
weak and the vagus nerves are overactive, the result is a sudden, life-
threatening loss of consciousness.
This disorder can manifest in otherwise healthy individuals and have
immediate devastating effects. While there is no evidence of long-term
consequences within the autonomic nervous system, vasovagal syncope is a
symptom of inadequate coordination. It is a common problem without a
specific single trigger. There are also several different factors, and the
pathways between younger and older people are somewhat different.
The most popular hypothesis is that a physical head tilt motion causes the
difference of sympathetic to parasympathetic behavior, such as sitting or
standing up quickly after lying down. This postural adjustment results in an
adjustment in the position of blood pooling, from inside the chest to inside
the abdomen, and in effect, the heart muscle fails to control its pumping
activities. A significant increase in blood pressure occurs with the increase in
the amount of blood being pumped out of the heart. The autonomic nerves
function to maintain stable blood pressure, but if they are unable to do so,
unexpectedly the blood pressure drops, which happens immediately before
the episode. If the body gets a moment to control the blood pressure, the
patient may regain consciousness and feel exhausted or nauseated because of
the changes that have occurred.
Although this hypothesis points to a physical cause for the fainting episode to
occur, it does not explain why the autonomous system can not control the
heart and blood vessels to ensure a stable posture transition. This is a kind of
dysautonomy, or the decreased capacity to control autonomous activity. The
mechanisms contributing to dysautonomy may be hereditary, such as with
Charcot-Marie-Tooth disease and Ehlers-Danlos syndrome, or they may
manifest externally, such as pregnancy, physical trauma, chiari
malformations, or surgery; Nonetheless, the most common causes contribute
to the conditions of immune and metabolic health. If the nervous system cells
lack the required nutrients for healthy metabolic responses or are coping with
elevated toxicity rates in the body, the nerves are not able to function quickly
enough. Perhaps more of a concern are autoimmune diseases affecting the
nerves themselves, as well as the VN-innervated organs and the emotion.
Such disorders include Parkinson's disease, sarcoidosis, Crohn's disease,
ulcerative colitis, Sjogren's syndrome, amyloidosis, and even chronic
polyneuropathy with inflammatory demyelination.
When someone is struggling with a condition like vasovagal syncope and has
fairly common spells of fainting, it is also a symptom of an immune or
metabolic disorder that may not yet be identified. Functional laboratory
research and functional neurology provide insight into the possible root
causes of this problem, which is often a symptom of malfunctioning nerves
within the autonomic nervous system and vagus hyperactivation. Changes in
heart rate, blood pressure, and cardiac production which can not be fully
controlled, are indicators that vagus and the autonomous nervous system are
not functioning optimally.
CHRONIC STRESS
Just imagine you're working out and lifting weights in the gym. You carry a
long barbell, which you raise from the shoulder to overhead positions
repeatedly. Every side of the bar has some weight but it's quite manageable.
Because you know this is a healthy burden on your body, you feel
comfortable when you are doing so. You are preparing your nerves and
muscles to lift this weight over your head and with each lift you achieve
successfully, you experience a greater sense of accomplishment.
Just imagine someone walking along and adding an additional 20 pounds to
each side of the counter. The weight still lies beyond what you can lift, but it
is beginning to get pretty heavy. Then someone else comes along and puts 10
more pounds to either side of the counter. You start struggling to raise the bar
overhead. We add 10 pounds more, and another 10 pounds more. You are
struggling seriously to lift the weight, and at this stage, even just keeping it
up is very difficult. You're sweating, nervous, and worrying about losing the
bar and potentially hurting yourself. Somebody actually steps in and supports
you by taking off the remaining 20 pounds on either leg. The weight has once
again become manageable. When your stress levels rise, the ability to manage
stressors increases, but if it is not held in check, the load may become too
heavy.
The weight on the bar is the stressors in your life in this analogy. In order to
learn, we all need to feel some healthy tension. Yeah, I said good stress, also
called ustress. These are obstacles that make us develop and experience the
best of ourselves. Some common forms of eustress include gym workouts;
traveling to see a new part of the world; raising a baby and helping her
develop into a healthy, happy adult; and a new romantic relationship, along
with the beautiful stressors that come with this. Those are all constructive
stressors which our bodies can raise from shoulder to overhead positions
fairly quickly and repetitively.
Nonetheless, external stressors sometimes come along and add extra weight
to our plate. They may be emotional stressors, generally referred to as
"distress." Some common forms of distress include financial stress, poor
interpersonal communication, health problems, and a loved one's death. Such
stressors can be viewed as negative and cause us to feel weighted down by
the weight we lift overhead. It may be appropriate to seek external support,
and in many cases recommended, to help take some of this weight off the
table.
The distinction between positive and negative stressors is not that one builds
you up naturally, and another knocks you down. The distinction, then, comes
from your understanding of the tension and the impact it has on you. This
may be a little abstract, but keep in mind because it is a very significant factor
in your wellbeing. When you think a stressor is positive, it will have a
positive effect, and if you think a stressor is negative it will have that effect
on you.
Parking your car far away from a store or mall's entrance has exactly that
impact. If you think it's bad and you're burdened with the long walk ahead of
you, the view is bad, and it will affect your mood as such. On the other hand,
if you believe the long walk is an opportunity for you to take a few more
steps in your day and enjoy some exercise, it will have a positive impact on
your mood and health. If you are interested in reading more deeply about this,
I highly recommend a book called The Biology of Belief by Dr. Bruce
Lipton.
Remember that in our lives, we aren't really conscious of all the stressors. On
the counter, we may be suffering from excess weight and not even know it's
there. The weight we bear somehow seems heavier than it does seem. The
stressors put on your bar are often invisible in the case of your wellbeing,
thereby burdening you with the weight you do not know. Some of these are
the product of behaviors we have, and may not know. I consider these
"lifestyle habits" and the good news is that you can change them once you
become aware of them. If you don't know about them, though, they can bring
extra stress to your body. Those stressors will be addressed in more detail
shortly.
Our bodies manage all forms of stress, exactly the same way, whether good
or bad. We are going from a relaxed state of rest and digest to a state of fight
or flight in which we can either stand up and fight or run away from the
stressor. The body should respond in the same way to negative financial
stress and positive exercise stress in the gym, experiencing the very same
cycle as our evolutionary ancestors who had to deal with the stress of fleeing
from a pack of sabre-toothed tigers and starting fires.
In the fight-or-flight condition, we start sweating, trembling, and pushing
blood flow away from the rest-and-digest organs into the arms and leg
muscles. The vagus nerve signals for blood flow in the rest-and-digest state to
increase towards the digestive organs and the parts of the brain which make
you feel rested.
There are not binary states. Fight-or-flight versus rest-and-digest isn't aswitch
you can flip to turn on or off like a lamp. But it is a continuum.
To order for our bodies to work optimally, we will be the vast majority of the
time on the parasympathetic side of this spectrum. Or put it another way, the
weight we bear on the barbell will be really convenient. We should be able to
bear it comfortably and operate well from inside. We will activate our vagus
nerve about 80 per cent of the time and stay in a fairly parasympathetic state.
However, it is crucial that we can rapidly and easily transition toward the
sympathetic state to handle stressors that can occur at any time. Thanks to the
neurotransmitter adrenaline and hormone cortisol, we seem to be able to do
this very quickly.
When an acute stressor happens, we make the leap to a high-grade
sympathetic state. Imagine what your physical reaction will be when you get
into a car accident, or when someone is jumping out of a door to scare you.
You get scared straight away and get into a defensive mode. Your heart starts
pounding, your eyelids close, but then you open your eyes wide to see
everything that's going on around you. You start taking fast, rapid breaths,
and you can start sweating immediately.
You can visualize how you feel when you're on holiday, lying on the sand,
listening to the ocean waves crashing nearby, to imagine the parasympathetic
state. Your body is comfortable, feeling like it can adequately eat, sleep well,
and recover from any stressors that might occur. It shouldn't shock you at all
that when you're on holiday, you feel so much happier and healthier.
Health concerns continue to arise when we are having difficulty going back
from sympathetic to parasympathetic mind. If the weight we are lifting is
very heavy and we have difficulty handling it, so it is hard for us to go back
to the simpler, easier state of rest and digest.
This scenario includes the stressors constant pressure and the assumption that
the stressors are negative. If we remain in this condition, we begin to shut off
operation of the vagus nerve; we avoid training it. Alternatively, we increase
the function of our sympathetic nerves continuously, with constant exposure
to low-grade stressors in a long-term way. When this persists for a long time,
we can gradually decrease nerve tone of the vagus and move towards
dysfunction of the vagus nerves.
Which are these low-grade, persistent stressors I'm worried about? Those are
the everyday life stressors–waiting in traffic on the way to work, going in to
work every day at a job you do not enjoy, thinking about the dinner you and
your family are going to have every night when you haven't prepared ahead
of time, etc. There are so many slight little stressors that add two, three, and
even five pounds to the bar you're carrying, and while each stressor's weight
is nominal and not very heavy, the total of all those small weights is much
heavier than we know. Such stressors create an imbalance in the role of our
hypothalamic-pituitary-adrenal (HPA) axis, which can hinder our ability to
control the energy and stress rates all day long.

It is not stress that kills us, it is our reaction to it.

--Hans Selye
If your body is filled with chronic low-grade stress most of the time, then you
won't be able to activate the requisite vagus nerve processes. Over time, this
low-grade sympathetic disorder may result in reduced parasympathetic
activity, resulting in increased inflammation, reduced immune cell activity,
impaired digestive function, less successful detoxification, and many other
health-causing issues. That is precisely why most people with health
problems continue to struggle with numerous health issues over their whole
lives. These are disorders that affect several organs, and each of our cells '
health.
One of the most significant factors in your wellbeing is your capacity to
return you from a supportive state to a parasympathetic state. Patients who
tend to get better quicker and achieve good results are the ones who learn to
build healthy lifestyle patterns so they can change their condition from
sympathetic back to parasympathetic quicker, more effectively, and more
readily. In order to be able to make improvements in stress levels, we must
first be able to recognize all the stressors our bodies might be experiencing,
in particular the invisible stressors that exist in our blind spots. Part 3 of the
book addresses techniques my patients use to recognize their stressors and
make meaningful changes.
It is not the load that breaks you down, it’s the way you carry it.
--Lou Holtz

INABILITY TO HANDLE STRESSFUL SITUATIONS

We explored many of the typical symptoms of vagus nerve dysfunction in an
interview with a friend and colleague of mine, Dr. Jared Seigler. Dr. Seigler
talked of patients who came in to see him for an examination, and these
people are struggling with high vagus nerve activity and complete sympathy
burnout. These people also have significant difficulties in managing stressful
situations. They're having problems with huge crowds, noisy noises, small
spaces. This is an autonomic disorder, triggered by the inability of the
vestibular canals to inhibit their emotional response.
If your sympathetic neurons are poor, then it will be very tough to maintain
an emotional balance, particularly in these situations. Such patients often
struggle with issues with their equilibrium, as the vestibular system is
connected to autonomous function and emotion control; they may also have
greater amounts of tears from the lacrimal glands and saliva production from
the salivary glands in the mouth.
Those are symptoms of imbalanced autonomic activity, biased towards
sympathetic vulnerability and parasympathetic dominance. Such signs can be
recreated in patients performing simple vestibular measures such as head tilt
exercises or turning around in a chair. Such movements can bring about
major heart rate and breath rate changes and contribute to digestive slowing.
As we have discussed earlier, brain power is dependent on nerve power. In
order to assess how powerful the vagus nerve really is, we have to check it
against a reference to find the best way to ensure that this device really
works.

LACK OF SOCIAL CONTACT

We need to have people around. Human contact face to face is of utmost
importance to our wellbeing. If youâ€TMve ever spent a couple of days at
home, alone, I’m sure you started to feel a little down and moody. Okay, this
isn’t just some sort of off - the-cuff feeling you have. It turns out that when
you're in a social environment and communicate with people face to face, the
vagus nerve actually gets triggered.
My mentor, Sachin Patel, pointed out to me that the punishment for doing
something wrong in jail is to be put in solitary confinement essentially by
yourself in a small cage without contact for hours and even days. They would
prefer to be surrounded by other convicted criminals, like killers, rather than
being locked in a cell.
A 2009 research in Health Psychology by Schwerdtfeger et al. found that
heart rate variability "a perfect way of assessing vagal tone” decreases in
people with less social contact and depressed mood. Depression symptoms
are found to be related to a lack of vagal speech. If patients with these same
symptoms were placed in social settings, their mood, variation in heart rate
and autonomic heart function would increase.
A research in Biological Psychology, by Kok et al., just a year later,
confirmed this observation. At the beginning of the program, adults recruited
from a university had their vagal tone tested, and again nine weeks later. It is
expected that individuals with higher vagal tone scores had higher increases
in communicating feelings and positive emotions. More specifically, at the
end of the test, these individuals also saw an improvement in vagal speech.
Depression is specifically associated with weak vagal tone.
Such findings show that our feelings of joy and positivity are directly linked
to activation of the vagus nerve and vagal tonus. In reality, those with higher
vagal nerve activity feel more positive and have more positive social
interaction. Depression and poor mood are associated directly with lower
vagus nerve activity rates.
This means the more optimistic, in-person social experiences you have, the
better you prepare your vagus nerve for optimum functioning. Persons living
in isolated environments with little social contact are unable to train their
vagus nerves to their fullest capacity and are more likely to suffer from
disorders of health triggered by rates of inflammation which the VN can not
regulate. Positive emotions construct physical health while negative emotions
cause physical dysfunction and illness.