How Inflammation Really Works and How to Shut It Down Feat. Dr. Kevin Tracey

Key Takeaway

Your vagus nerve acts as the body's natural brake on inflammation. Recent FDA approval of bioelectric vagus nerve stimulation for rheumatoid arthritis marks a revolution: 75% of patients who failed all medications gained significant relief with just one minute of daily electrical stimulation. This breakthrough suggests that within years, bioelectric medicine could replace pharmaceuticals for treating inflammation-driven diseases from depression to diabetes.

Episode Overview

Dr. Kevin Tracy, pioneer of bioelectronic medicine, reveals how the vagus nerve controls inflammation and disease. His groundbreaking research led to FDA approval of vagus nerve stimulation devices for rheumatoid arthritis, showing 75% effectiveness in patients who failed all medications. The episode explores how childhood trauma creates lasting inflammatory responses, the connection between mental health and physical inflammation, and the emerging field of bioelectronic medicine that may replace drugs with targeted electrical stimulation.

Full Transcript

Transcript of How Inflammation Really Works and How to Shut It Down Feat. Dr. Kevin Tracey from The Ed Mylett Show. Auto-generated from episode audio; may contain minor errors.

The fundamental discovery of the link between the vagus nerve and inflammation that we made was that the vagus nerve is sending signals that act like the brakes on your car. If inflammation is barreling down the hill and the brakes fail, all kinds of problems will occur. The FDA approved the basis of this idea as a new therapy to treat inflammation in patients with rheumatoid arthritis. I think this is launching a whole new era in medicine where bio electronic medicine will begin to replace drugs. That's a big statement.

It's a big statement, but it's backed by the facts. I see a world very soon where many, many people with rheumatoid arthritis in the United States will have this as a therapy. I have met some of the patients who spent 12 or 15 years in and out of wheelchairs using a cane, which she no longer needs. Her therapy is Vegas nerve stimulation. She's now seven or eight years out from the implants. Do you think that there's applications in diseases beyond arthritis? 100% I do. People who were suicidal, unable to care for their families, unable to work, and now they're not suicidal, they're caring for their families, they're back at work.

So, what is the cost benefit of that? Is it possible that the Vegas nerve stimulation is reversing the inflammation that's causing the depression? It's really incredible, actually. actually. actually. It is incredible. Welcome back to the show, everybody. So, I have to tell you, we get, you know, I don't know, 800, a,000 requests a year to come on the show. And about 10 times a year, I request somebody to be on the show. And I was just telling this gentleman off camera that he's one of those people.

I have really wanted to talk to him for a while. And uh you'll know why when this hour is over. You're going to learn a ton today, everybody. You're going to learn a ton about your parasympathetic and sympathetic nervous system. You're going to learn about your vag nerve. You're going to learn about healing, anxiety, trauma, uh, longevity, all kinds of stuff. And I guarantee you there's going to be a ton of things that we're going to cover today that you've not heard before in your life.

So, this is heavy notetaking stuff. My guest, I don't know what I would call him. He's an interesting man. I guess he's the I guess I call him the father of bioelectric medicine. I think he's one of the most important people on the planet today. I think he's creating a medical and um, mental health revolution for many people. He's a neuroscience, neurosurgeon, a scientist and um but more importantly than all of that, he's been somebody that's taught me a great deal and I think he's going to teach you a great deal today.

You need to get his book, The Great Nerve by Dr. Kevin Tracy, who's my guest today. Dr. Tracy, welcome to the show. Thank you so much for having me on. I'm really looking forward to chatting about one of my favorite topics, and thank you for your kind words. Well, you know, I feel very strongly about this. So, and by the way, everyone in my private coaching work, I do a lot of work on your sympathetic and parasympathetic nervous systems and how trauma affects us internally. And so, he's going to give you the the the master class cuz I do the kindergarten class.

So, let's start out today. This is some basic education, Dr. Tracy, because for some people, they may not know. Let's just start out with what is the vagus nerve and why does it matter? The vagus nerve is a nerve that starts in the base of your brain at about the level of your ears and travels down your neck across your chest into your abdomen and along the way it sends it sends branches branches branches or fibers out and touching all the organs you never think about.

Now now we call it the vagus nerve but you actually have two of them like two thumbs and two kidneys kidneys kidneys etc. etc. etc. And these two two nerves on each side are even more complicated than that because within each of these two nerves in humans is a 100,000 fibers 100,000 individual nerve fibers. So when when when you talk about your vag nerve, you actually have 200,000 of them. And all day long the signals traveling up and down from your body to your brain in the vagus nerve and then back down from your brain to your organs.

These signals are the fundamental basis of reflexes that operate to keep your organs functioning in a harmonious healthy way. In other words, your heart and your kidneys and your lungs, they're all working all day long in a balanced harmonious way when you're healthy because of reflexes traveling uh largely in the vag nerve. Gotcha. And that matters. Why? Let's let's let's dive deep into some stuff here just for some basic stuff. I think it's been established sort of in the medical community the last decade or so that inflammation that inflammation that inflammation is probably the root of most disease in the body.

you correct me for all the things I say that are wrong today because there'll be a bunch of them. But assuming that that's sort of become the new foundational basis for what most people believe about disease in the body that matters why as it relates first off is that probably true and if it is true why is that matter in relation to the vagus nerve inside our bodies? It is true. And just to make it very concrete for for for those who might be interested, every year on the planet earth about 60 million people die.

Uh, according to the WH, twothirds of those deaths are caused by conditions that you just alluded to, sort of chronic diseases that can that that kill twothirds of of people who die every year include cancer, heart disease, stroke, stroke, stroke, diabetes, metabolic syndrome, obesity, and neurodeenerative conditions such as Alzheimer's disease and Parkinson's. So, as you alluded to correctly, what those conditions all have in common is that inflammation either causes them or contributes to them by making them worse. And so the the question that I've been thinking about for going on 40 years now in my laboratory at the Feinstein Institute in New York is what is it that that drives inflammation at the level of of molecules individual molecules and cells and how can we use that information about what's driving inflammation in the body to stop inflammation.

inflammation. inflammation. Now, in in the late 80s, 1980s, my colleagues and I made some contributions to developing molecules that stop inflammation in in many patients. And those molecules today go by the name of biologics. And you see them advertised on the nightly news. You see them advertised on all the Sunday football games. These biologics are many of them are monoconal antibodies. and they they bind they stick on cytoines which are molecules made by white blood cells and these cytoines can cause inflammation. So that's what we've known since the 1980s and these these drugs are very powerful and they they treat patients with conditions like rheumatoid arthritis and and other conditions but they don't cure the they don't cure the disease.

So some some other things are still going on. And so the fact that these these these biologics don't cure inflammation but can slow it down taught us that these molecules are very very important in causing inflammation. But I found myself years ago wondering well if if the immune system has the and our bodies have the ability to make this these powerful inflammatory molecules which can cause harm. it it can cause serious damage to your organs if there's too much inflammation and it can contribute to these other illnesses that that can that can kill so many people every year on the planet earth.

And the real question I have was how does the body normally control inflammation? inflammation? inflammation? Now if if if if you take what we just talked about from the vagus nerve and I said reflexes are controlling the healthy balance of your organ functions. We've known for over hundred hundred years or more that reflexes traveling in the vag nerve control how fast your heart beats. If it beats too fast, signals in the vagus nerve slow it down. Reflexes in the vag nerve control how much insulin your pancreas makes and how much glucose your liver can produce.

So if you if this is what we've known all along, the question to me became, well, if reflexes are doing things to all the other organs, is it possible that reflexes in the vagus nerve are also controlling inflammation? That was the Eureka idea. That was that was the Eureka moment. But as you know uh from the book, we don't say Eureka in the lab anymore. We say holy Right. And by the way everybody, we're going to cover so much today that by we're going to talk about trauma here in a second too.

So it's there's so much to this inflammation, vagus nerve, the sympathetic nervous system. There's so much to it, you guys, that over the next 5 years. You think AI is a revolution? And by the way, it even fits inside this discussion. This is going to be a revolution. I'm telling you, it's been part of my work for a long time on just performance and well-being. But so one more foundational thing I just want to lay out there is there used to be this adage that you know Plato said a long time ago uh you can't heal the body without healing the soul right and there's this adage there's a lot of uh you know growing up there were these you know theories of well if you're if you've got trauma and you're under great stress you're going to you know you're going to die younger and that was kind of theoretical of theoretical of theoretical but now we actually know don't we?

So explain to us a little bit foundation and then we're going to get into some great stuff. How does trauma um anxiety trauma in our life or anxiety or things that happened in our childhood or in our lives actually affect this inflammation in our body like you've you've essentially we've proven this now. So like give us the correlation of why unhealed trauma is detrimental to your physical health not just your mental health. mental health. mental health. So Plato Plato was right. I happen to agree with him and uh and and your quote from him is spoton.

If you think of the signals traveling in the nerves as controlling all your organs, then the fundamental discovery of the link between the vag nerve and inflammation that we made was that the vagus nerve is sending signals that act like the brakes on your car. So if if inflammation is is barreling down the hill and there's nothing and the brakes fail and inflammation spins out of control, then all kinds of problems will occur. So we we can take that now as a fact. and the the revolution that we're coming into and living through as we speak.

As of six or seven weeks ago, uh on the day that we're recording this, the FDA approved the the the basis of this idea as a new therapy to treat inflammation in patients with rheumatoid arthritis. And I think you're right. I think this is launching a whole new era in medicine where bio electronic medicine will begin to replace drugs. So that's a big statement. It's a big statement, but it's backed by the facts and it's kind of fundamental as you said, laying the fundamental groundwork to this conversation.

When when you look at the uh the role of of childhood trauma and uh inflammation and long-term health, the the results are absolutely fascinating. And I know that you've talked about this in the past on your show and you've read these papers, but one of my favorite studies that nails the point of this is if you look at elderly graduates from college and gave them a survey and said, "Okay, what was your father's income when you were I forget four or between four years old and 10 years old or something like that." that.

And so these people filled out the survey and they made an estimate of of whether they were rich or poor by their by based on their father's income when they were little. And then the the the researchers measured salivary cortisol in these patients. And what they found was a near perfect correlation correlation correlation uh inverse between their father's income and how much uh salivary cortisol was present and meaning how much stress their body was carrying throughout all those decades of life. Five, six, seven, eight decades of life.

The lower the income, the higher was the cortisol and the saliva. So what does that mean? That means that the the nervous system, the brain, which controls the pituitary gland and the pituitary adrenal access that makes steroids, the nervous system, it carries an engram. It carries a memory or an imprint of the stress that occurs when you're young. And that can be translated back to the body in this case through signals in the pituitary adrenal access. But if you look at other indicators that say heart rate, resting heart rate or resting heart rate variability, there's evidence and those sorry those those are controlled by nerve signals not hormonal signals.

Right? Right? Right? So signals in the vagus nerve which is parasympathetic and signals in the uh sympathetic nervous system either accelerate or decelerate the heart. that balance lives in if you will in the brain stem in the brain and that turns out to be influenced by childhood stress and those effects can last for many many years. So if signals in the nervous system can be modulated by childhood stress, that's a fact. And if signals in the nervous system can turn on or turn off inflammation through the vagus and sympathetic nerves and that's a fact, then the answer to your question is yes.

There's definitely a relationship between between between uh stress nervous system control of inflammation and how much inflammation you you bear in your body which of course then can put you at risk for uh complications in your organs from too much inflammation. much inflammation. much inflammation. Let's talk about how that might work. by the way. Isn't this fascinating everybody? So, and by the way, there's ways everyone pretty simply that you can actually see how you're doing with this stuff. So, let's um let's use me for a second.

Okay. So, u first off everybody give yourself the gift of just learning a little bit about the sympathetic nervous system. We're not going to get too much into that today just because there's too many other things to cover. But let's just call the sympathetic nervous system for the layman. you're in a fight orflight mode to a you're in a fight orflight mode to some extent. So take a guy like me. I grew up with some childhood trauma. Um alcoholic father. Got sober when I was 15.

But those first 15 years were a lot of anxiety, a lot of stress, a lot of worry. Also in my family, I think a a little scoch of mental health issues, little maybe a scoch of depression in there, like a touch, you know what I mean? And so I think I grew up in a fight orflight mode in my sympathetic nervous system. I wasn't parasympathetic very often. Now I find myself at 55. I've had some health issues in my life. And um my resting hor I'm fit.

I work out 5 days a week. I'm in the gym. I've got low body fat. I've I've been fit most of my life. Yet my resting heart rate's almost 80. And my HRV is incredibly low. like last night was 11 most nights it's like 15 does that mean those two metrics tell you can you can educate them on HRV as well a little bit does that mean is that indicative that I am probably in sympathetic nervous system mode and not parasympathetic most of the time uh is that what that would indicate in other words high heart rate low HRV is that indicative of somebody that's uh in fight orflight mode most of the time more than likely there are some that would say that to you that yes, it is.

Uh I'm not sure. I I would be much more honest and say I'm I'm maybe before I drew a conclusion, let me back up a second. The the problem with some of these things is when all the data fits uh with a dogmatic idea, it's very easy to jump on the answer being the dogma. The problem is when you scratch the surface of the dogma and try to understand where do these definitions and measurements come from, you realize that you kind of run out of data really quickly.

So in the case of measuring uh fight or flight, you would want more than just knowing your resting heart rate and your heart rate variability. You really would also want to know uh your hormone levels and your levels of you know cortisol is one we talked about a minute ago. You would want to know your cortisol levels. You would want to know your norepinephrine or or epinephrine levels. Those are very hard to measure. They have to often measure the byproducts or the metabolites of those in either blood or urine.

You'd want to have a much more sophisticated analysis and you would want to have it o over long periods of time for many days in a row. So think of the example of of of diabetes. patient's worried about measuring her glucose levels and and she's a diabetic, she might take a glucose measure at some random time of the day and see it's perfectly normal and then go ahead and have whatever a candy bar or an orange and then not measure till till sometime later and see that it's still normal.

So, okay, I don't have diabetes. But if she measured her hemoglobin A1C, which integrates the glucose levels over many, many hours, days, and weeks, she would find that the hemoglobin C was off the charts because the glucose was spiking intermittently. We don't have quality measures for inflammation frankly or for um sympathagal balance. There are some that advocate for using heart rate variability as a gold standard of sympath. But that's also actually much more controversial than you would ever figure from looking at social media. Uh what is heart rate variability?

So if you look on an EKG, you you see each heartbeat. Or if you feel your pulse, you feel a distinct beat uh beat of every heart in your wrist or your neck. If you actually have a stopwatch and measure the time between individual heart rates, you can write down all those times in sequence. And then you get a long sequence of numbers that are called instantaneous heart rates. Now, when the vagus nerve fires, it prolongs the time to the next heartbeat. That's why vagus nerve slows your heart because it prolongs the time between heartbeats.

If you have a lot of vagus nerve activity and that's happening um frequently now you have you can subject these data which uh which can be obtained on uh EKGs for instance or halter monitors where you can follow EKG signals for many many minutes or hours. You can you can add up and uh and analyze with with statistical algorithms all of these instantaneous heart rates and you can derive uh predictors of that that that guide us to what we call heart rate variability and people refer to this as veagal tone.

If you look at the high frequency domain after sort of a forier transformation of these complicated data, there's a little spike which has been correlated with vagus nerve activity in in humans. But is that the whole answer? is that the whole answer? Well, it depends on the algorithm, right? So your Fitbit and your Apple Watch and your other wearables, they're all using different algorithms and they're all proprietary. Mhm. So, one person's heart rate variability may or may not be being measured the same as another person's.

Okay, everybody, I want to uh I want to get you in the weeds here. We're going to talk about solutions here in a second and why it matters. So, stay in here. And it does matter. Okay. So, you say in the book that the brain listens to the body and then it talks back through the vagus nerve and with the right tools, the body can heal itself. And it starts with the great nerve. So let's actually prove that. Let's talk about this. So I'd like you to talk about this is going to blow your mind everybody, but the work that's recently been approved as it relates I think in the book I'm reading about arthritis, rheumatoid arthritis, and the work you've done.

So he said something pretty controversial earlier guys, which essentially is that I'll call them pharmaceuticals, but that essentially maybe electricity in the body and ability to stimulate itself that way could replace or at least mitigate the use of pharmaceuticals. you go, "No way." Well, actually, here's some studies and some evidence that will maybe begin to change your mind about this. So, why don't you tell them a little bit about basic concept that, you know, that the the brain listens to the body and what you believe with the right tools the body can begin to heal itself and it starts with this nerve.

Give them that foundation and then the work you've been doing with arthritis. It's just guys, you're not going to believe this. It's a fascinating observation that if you inject uh inflammatory molecules, molecules that produce inflammation in either a mouse or a man that that those molecules will cause the mouse or the man to develop what we call sickness behavior. So, anorexia, depression, uh withdrawal, social withdrawal, these effects are very real and you've all experienced them if you've ever had a bad case of the flu, uh where you just want to crawl in bed, you don't want to eat anything, you don't want to see or talk to anybody, you don't even want to uh engage in any hobbies because you just withdraw.

those molecules, those cytoines like TNF and IL1, they produce those effects because when they're in the body, the vagus nerve senses them and the vagus nerve carries electrical signals from the body up into the brain that basically tell the brain, hey, there's there's a lot of cytoines in the body and the brain's response is to produce that depression, that fatigue, that behavioral withdrawal, and that anorexia. So this this has been proved in animals because if you cut if you cut the vagus nerve in animals which you can do uh in mice you can't do it in people but if you that the and then give those cytoines the mice don't get sick.

It's very remarkable. It's very remarkable. So what happens to to those signals going up into the brain? Well, the brain is processing the incoming signals as as too much inflammation in the body and it sends signals back down the vagus nerve to turn the inflammation off. And that basic discovery which I I alluded to before as the brakes like the brakes in your car that are the brakes on your inflammatory response that allowed us to write on the back of a napkin in 1998. Well, if the vagus nerve is is using electrical signals to turn off inflammation, we should be able to develop a uh to engineer a biomedical device that we could implant on the vagus nerve to activate those breaks to to stimulate those signals.

And those signals once stimulated would would break or slow the inflammatory process. And so that was that was on the back of a napkin in 1998. We worked on this for uh six or nine years to prove to ourselves that it would work uh safely in animals. And in 2007, I co-founded a company called Setpoint Medical, which is the company that developed the device I just described and and prove that it works. The device is about the size of a multivitamin or a fish oil pill.

It sits uh under the skin under the strap muscles in your left neck at about the level of your Adam's apple. And it delivers for one minute a day a small pulse of of electrical activation at 400 micro amps. I mean, it's almost nothing for one minute a day. Many of the patients actually sleep through this one minute a day. They don't even know the treatment's happening. But because this treatment activates the inflammatory reflex, which is what we call it, and turns off inflammation, what we're seeing is that in a clinical study of rheumatoid arthritis patients, now these patients were not benefiting from biologics.

They were not getting better. They still had severe disease despite the fact they tried all these powerful medications. And what we saw was that about 75% of them gained significant clinical benefit uh from having Vegas nerve stimulation implanted in their neck. It's really incredible actually. It is incredible. And you know everybody there's so much done Packer. This should be a four-hour show. But if it begins to make you make you make you I got time. I got time and you do. Why? By the way, maybe we'll do multiple shows.

shows. shows. It starts to make you wonder everybody what are the other applications and implications implications implications of this vag nerve stimulation doesn't it? And um I mean are we going to have a world in your opinion someday? You said electricity over chemistry someday in the body. Do you think, you know, in the next 5 or 10 years, you're going to see a world where we're running around with these chips stimulating our vag nerve to to help reduce or mitigate diabetes or rheumatoid arthritis, heart disease, cancer.

Do you see a world like that or is that premature to say that that's possible? I see a world very soon where many many people with rheumatoid arthritis in the United States will have this as a therapy. I have met some of the patients. I have met um Kelly Owens who spent 12 or 15 years in and out of wheelchairs using a cane um which she no longer needs. I mean she gave me her cane. It sits in the corner of my office now. Her therapy is vag nerve stimulation and she's now seven or eight years out from from the implant.

So the effect is durable. I've met uh a teacher uh who has a ve who has a a a it's called an amuno regulator from set point this vagus nerve stimulator in her neck and and she said it wakes her up at 4:30 in the morning. I said, "I'm sure that I'm sure the engineers can change it to stimulate your vag nerve at later in the morning so you can sleep in." She goes, "No, no, Kevin, I don't mind." I said, "Why don't you mind?" And she said, "Because I'm a teacher and for years I would wake up in the morning at 4:30 and with pain in my hand so severe that I would cry because I was afraid I wouldn't be able to get dressed to go to work or pick up a pencil." She goes, "Now I wake up at 4:30 in the morning and this thing buzzes and I smile because I don't have any pain in my hands." hands." hands." So you were careful there.

I watch you. You were careful to say rheumatoid arthritis. I'm not asking you to predict. I'm asking you your opinion. Do you think that there's implications or applications in diseases beyond arthritis? arthritis? arthritis? 100% I do. Uh I'm painting right now the fact that there's a pond covered partially in pond liies and we know the doubling time of the pond liies and we know the surface area of the pond. I think you can make very concrete predictions about a significant use for rheumatoid arthritis in the US based on the current FDA approval.

Because of that, it's a baby step to look at other inflammatory conditions where we already have data either in humans or in laboratory experiments. In humans, there's very convincing data in small trials. It'll have to be repeated in larger studies for the treating Crohn's disease, inflammatory bowel disease, and ulcerative colitis. There is very compelling animal um results in multiple sclerosis and I think you're going to see SetPoint announcing if they haven't already clinical trials to treat multiple sclerosis and that'll happen immediately that you know if if it's not open now those trials will be open soon.

you're going to see uh news about the possibility to use various vagus nerve stimulationbased therapies to treat diabetes and potentially even metabolic syndrome or obesity. There's fascinating data about the relationship of vagus nerve stimulation to enhancing neuroplasticity neuroplasticity neuroplasticity which is the phenomenon that can enhance recovery from injury and stroke. And the FDA has approved that indication already. There's fascinating data in in treating depression. More more hundreds of thousands of of people have already received Vegas nerve stimulation therapy for treating epilepsy and depression. Now, what's fascinating to me about depression is it works really well, but only about half the time.

So what is it about those 50% of patients that get better uh from Vegas nerve stimulation therapy versus the 50% that don't that has frankly slowed its use its adoption into widespread practice. uh prescribers don't like to not know the half, right? It makes sense. On the other hand, some of the responses are people who were suicidal, unable to care for their families, unable to work, and now in if they're in the half that respond, they're not suicidal, they're caring for their families, they're back at work.

So, what is the cost benefit of that? And my question in these kind of situations is, is it possible that the vag nerve stimulation is reversing the inflammation that's causing the depression? So, these are the kinds of questions that I I guarantee you're going to see a huge amount of new work being done in the next few years. Guys, is this crazy? By the way, in a minute we're going to talk about daily practices that you can implement that are simple to help stimulate the vag nerve or potentially um move you into parasympathetic mode here.

But before I ask you that, I want to ask you, you know, your take on these devices that are available in the market. They sit on your ear. I won't name them, but I've got four of them next to my bed right now. I've tried all of them that uh are these devices that um suggest that they can stimulate the vagus nerve by some stimulation on your ear. There's a couple that work on the neck supposedly. neck supposedly. neck supposedly. um are is it do what are your thoughts on those without as you know because you read the book uh I have a lot of thoughts on this and some some are good and some are not so good.

So let's just recall what I said in the beginning you have a you have two Vegas nerves but you actually have 200,000 Vegas nerves. So it's complicated. Uh, it's complicated because each and every one of those fibers, 200,000 fibers, was honed and perfected by millions of years of evolution to start at a particular place in your brain or body and go to a particular place in your body or brain. So, it's got it it's got its own path. It's got its own root. It's got its own destination and origin and it has its own function.

So, when someone says to me, I want to stimulate my Vegas nerve. I say you you have 200,000. Which one do you want to stimulate? And what we've done with the set point device is we figured out that 400 micro amps only stimulates a a few hundred maybe a couple thousand fibers and those happen to be the fibers that stop inflammation. So that's the good news, right? A very low amount of current driven directly placed directly on the vagus nerve can do a specific thing because it targets specific fibers.

That's not true when you put electric current in your ear or on your neck. It's not possible to have the evidence in humans yet because we can't measure the vagus nerve uh electrical signals which would be the ultimate proof that you've stimulated the vagus nerve unless you're putting a device on the vagus nerve. The reason people are interested in putting a device on the ear for instance is because there's a branch of the vagus nerve that goes to the cartilage of the ear, a small part of the cartilage, the outside of the opening to your ear.

It's called the simoca. Now that's a sensory branch which means it's carrying information about what's happening in the cartilage into the brain uh into your brain stem and it happens to go to the place where all the other incoming information goes from the vagus nerve. So that's interesting and there's pretty good evidence uh from many studies that if you put uh a small amount of electric current using a TENS unit a transuricular epidural nerve stimulator that you can now put people in brain scans and you can actually show that the act that that the areas of the brain that are activated by a TENS unit in your ear correspond to uh many of the vagus nerve centers in the brain.

So that so far so good. That's interesting. Um, and then you can do clinical trials and you can study the effect of a 10 unit in the ear on on all kinds of things. Opio withdrawal, migraine headaches, um, inflammation in various conditions, whether it's Crohn's disease, we've done that. We've done arthritis associated with lupus or you can do blood tests and look at inflammation and we've done that. Now, what you see in these small studies often times is some signal. you see the less inflammation. That doesn't prove it's a vagus nerve stimulator.

Okay? Once you drive those signals from the ear into the brain, the brain has 100 billion neurons and trillions of synapses or connections. So, it can do whatever it wants with it. It doesn't mean that there's a direct path from your ear to your spleen to stop the inflammation that's headed to your intestines or your wrist. So, that's where it breaks down, right? It's like correlation is not causation, right? The the correlation between some clinical benefit from doing something in your ear or your neck doesn't prove that it's a Vegas nerve stimulator.

Putting all that aside for a second, if you can afford to buy, you know, a half a dozen devices and play with them at different times of the day and night, if you like to self-experiment, self-experiment, self-experiment, if your doctor says it can be safely done, that's all fine and good. But some people can't afford these six devices and they buy them because they're out of options and they're desperate and they're reading crap on on some website selling something that's exaggerating the the clinical benefit. That's where I kind of recoil a little bit because at the end of the day you you have to either understand the scientific mechanism of action which I just explained is impossible or very difficult with a 10 unit in your ear or you have to have large well-controlled randomized clinical trials that have been validated by the FDA and in most cases frankly those things are just so I wrote the book to explain all this not to attack anybody not to criticize anybody and like you I I don't name the names of these devices because frankly some of these non-invasive some of these non-invasive devices do have interesting clinical uh outcomes and clinical results.

They're just not Vegas nerve stimulators. The only way to stimulate the Vegas nerve is to put an electrode on the Vegas nerve. I love your approach, by the way, and your your um your demeanor. Let's talk about stuff that doesn't cost anything. Um Um Um that's even more interesting, right? It is. So, I'm going to throw two things at you and they're not correlated, but they're two things I do pretty regularly. So, by the way, and they're they're one of them's really in vogue. So, what about prayer and and these are completely disconnected things, but they both don't cost anything.

And so, prayer and is that a biologic tool? Is it a spiritual tool? Is it both? Um, so I'll give you these prayer/meditation these prayer/meditation these prayer/meditation and just cold therapy in general. Just speak to those and why they matter or don't for you. Let's do them in the opposite order if you don't mind. Yeah. Yeah. Yeah. So, I I am a fan of cold therapy. Uh, a couple times a week, I'll put the shower on full cold at the end of my normal shower and I'll stay in there for a bit.

And let's just talk about why I do it and and what I think's happening. uh what the ev not just what I think what I think is based on studying the evidence the the normal caveat please check with your doctor there are patients who should not do this without checking with uh with their doctor to make sure that that that they don't have a figning episode or or or problems with their heart. But what happens when you step in that full cold shower is it hurts.

It's uncomfortable. All the air goes out of your body. You feel like you can't breathe. It's terrible. And uh people say they enjoy it and I I I have a more nuanced view of that kind of enjoyment. And I wrote about this and I I see you smiling. It's it's really much more like I've done it for now uh for several years a couple times a week and every time I step in that because I step out of the hot shower, let it get cold and then step back in.

And every time I step back in, half of my brain is screaming, "Don't do it, you fool. You fool. You fool." And then you step in and it's highly uncomfortable. And and I'm not I don't think you get used I It's not that you get it's not that you get used to the discomfort. You're fully aware of it, but it just doesn't bother you in the same way. And the way I describe it is I feel like boy, that person doing that cold water thing is really foolish and and is really suffering and uncomfortable, but it's like I'm watching that person rather than fully experience.

The first time you do it, you fully experience it, right? And and I and I highly recommend the first time you do it, you don't do it. You you don't do full cold. There's no reason to get you can work up to it over a period of days or weeks. Now, that is fight or flight. You talked about it before. That's fight or flight. And what we've we know from I mean, we've infused fight-or-flight hormones in in human volunteers on shore leave and we've we've studied this in animals.

the acute fight or flight, which is what's happening. Your heart rate races, you've got that horrible feeling you can't breathe. Those hormones turn off inflammation. So, for me, check the first box. first box. first box. Right? Right? Right? If the whole idea is to have an anti-inflammatory sort of experience, um, check that box. Then, I stay there. Sometimes I I I hold my breath while I'm doing this and and I stay in the cold until, I don't know, until I feel my heart rate slow down.

And at that point, I know I've stimulated the vagus nerve. I I I hope that the fibers that to the heart are also um because I've stimulated those and my heart rate slowed. I hope I hope I've also stimulated the fibers to to slow my inflammatory response in my spleen and elsewhere. But that's a little more difficult to prove. and and the studies on on cold exposure, adapted cold exposure, where people um there's there's some studies from Scandinavia where they took uh soldiers, military types, and they put them in a cold room, like four degree centigrade cold room, and sprayed them in cold water and put a fan on them and they let them stay there for a long, long time.

Some of those studies show pretty decent evidence that their heart rate slow down and their inflammatory responses are slowed down. So that's why I do it and that's how I put it together. The fight orflight, that acute stress response, that's a massive fight orflight response. That's anti-inflammatory. And then the cold adapted response is a vagus response and that's anti-inflammatory. But you know what about then the chronic stress you talked about earlier in the show in your own life and in in your listeners lives. Chronic stress is not really full-blown fight or flight that we just talked about.

Chronic stress is lowgrade persistent fight or flight. It's not the same thing. Lowgrade chronic fight orflight stimulates inflammation. And that's that's really important. So you can have it both ways. Fight or flight can be good for you. And that's probably what happens when you exercise. Exercise is a form of controlled good stress, controlled fight or flight, but it's that chronic gnawing away, eating at you fight or flight at low low levels that actually produce inflammation. So that's why I do the cold showers. Now there's other ways of doing it.

And there's people advocating in you know there's billions impression of of web impressions on Vegas nerve and cold billions and everyone's uh some of them are based on good science and and some of them have to be treated with a little bit more caution in their interpretation. interpretation. interpretation. What about prayer? So prayer is complicated because it involves involves involves relaxation responses and it involves changes in your breathing. And so, um, the simple answer is if you wanted to take it to the highest level as as you suggested in the beginning of the show, if you check your pulse and you have a slow, uh, pulse during prayer, you maybe you've stimulated your vagus nerve by the by by prayer, but you said, is it spiritual or not?

Well, that's hard to prove, but you can prove to yourself that by changing your breathing pattern, you can slow your pulse. So, you could do it right now, right? You can check your pulse and you can breathe in on three slowly through your nose. What happens when you take three sort of big breaths, three seconds, one, two, three seconds. Usually some people advocate taking it as sniffing through your nose for three seconds. You fill those lungs. You've stimulated your vagus nerve. But but let's talk about that specifically.

What you've actually stimulated are the sensory fibers of the vagus nerves from your lungs to your brains because you've expanded your lungs that stretch the signals goes up and and they tell your brain, okay, this guy or gal has has filled their lungs and uh that so you've stimulated your vagus nerve. Is that really the same thing as as the fibers that go to your heart or your spleen? Not really. But then what happens after the signals go into your brain? Now you exhale for 7 seconds.

And if you check your pulse, you'll feel it slow. That's called respiratory sinus arrhythmia. And now you're breathing on a a 10-second cycle. 3 + 7. And that would be six breaths a minute. If you keep doing that uh for a few minutes, you you'll know you'll notice during exhalation that your heart rate has slowed because the signals from your brain are traveling down your vagus nerve to slow your heart. Now, if that happens during prayer prayer prayer or any type of meditation or relaxation therapy, then yeah, it it's it's a good thing to slow the vagus nerve to stimulate the vagus nerve and slow your heart.

Hopefully, it that those those methods are also slowing the amount of inflammation that your body makes, but it's very very difficult to prove that. It's not well proved, right? Isn't this good, you guys? All right, a few more things and I want everybody to go get The Great Nerve by Dr. Kevin Tracy. That's what you need to do. It's I read it in two days and uh I wanted it to even be longer. It's it's it's it's not a book that when you're done you're like ah that went too many chapters.

It's you you even want more. It's that good you guys. Um I want to ask you about this inflammation thing and then I want to talk about heart and brain coherence. brain coherence. brain coherence. Uh my friend Dr. Dr. Joe Despensza talks about um so I want to understand this inflammation thing a little more. We're kind of going backwards but we're not. My dad died My dad got cancer in his uh early 60s and he lived for about 8 years. He died in his early 70s.

My dad was very fit. Um worked out all the time, ate clean, didn't drink for 35 years, quit smoking 40 years ago. And I always is the idea that when you have chronic inflammation in your body, am I way off on this? My dad was a stressor. My dad worried. Like just you'd walk in a room and I love him, but he'd almost, you know, he'd sigh. I'm like, "Dad, what's wrong?" I don't know. You know, just like that was his normal disposition. You know what I'm saying?

And I would have loved to seen his HRV and his resting heart rate and all this other stuff. But is the idea that if you live in that mode, am I crazy to think that it may trigger some form of gene expression in your body prematurely? Meaning, and I know there's no proof of this, I just want your opinion. Meaning, you know, you're predisposed to get cancer. Maybe it should have been triggered in your 80s, but you've just lived in this inflammatory mode all your life.

And so, this expression, frankly, cranks on younger and earlier in your life than it would have otherwise. Am I out of my mind to think that there's a correlation between those things or do you what do you think? And I know you're a doctor and we need randomized controlled blind stuff. I get all that, but just what do you think? Well, I think that this could be the topic of another 4hour show. That's the that's the simple answer. Uh it's complicated because it goes both ways.

That's at the end of the day, that's the simple answer. What happens in your brain affects what happens in your body. What happens in your body affects what happens in your brain. So, tuck that away as the answer. But the second answer is it's genes and environment. It's nature and nurture. And you can't separate those. So, you uh let's do that one first. So, two guys are playing golf and they get hit by lightning and they both get killed. Is that genes or environment? You tell me.

Well, it's environment, right? And then and then I tell you it's a father then I tell you it's a father-son combination and they play golf in Friday every weekend uh in the summer when the when the lightning comes out. So now it's jeans and environment right so the same the same kind of logic can be applied to everything you just said happened uh to your dad. So let's just we'll we'll play it backwards and forwards. Um let's talk about the anxiety and the the worry first.

So obviously uh it's possible that as they as as people like to say uh there's an imbalance of neurotransmitters in the brain that that that contri contributing to have him having annoying depression or annoying anxiety. Well, it's possible, but there's no proof of that. The most commonly the most commonly used anti-depressants in the world, the the SSRI, the serotonin based drugs, there's zero evidence linking serotonin as a causitive factor in in depression. Zero. The only evidence for uh for serotonin that has stood this test of time is is a is a secondary evidence.

Meaning that some people who take SSRIs have less depression. That doesn't prove cause and effect because SSRIs do other things in the body. They don't just go to the neurons in your brain that allegedly have a serotonin problem. Okay? So, we don't understand that. We don't understand depression. That's the point. However, we do know that SSRIs in uh in various conditions they've been studied are anti-inflammatory. So now what about this scenario for your your dad, your poor dad uh lived his whole life maybe induced by uh by drinking a extra pine or two along the way or maybe because he had an underlying viral infection but deep in his tissues he had inflammation.

And I already talked about it. The inflammation in the body sends signals up the vagus nerve which cause depression. What if that happened to him? That's very possible. And maybe that depression uh altered the balance of his sympathetic and parasympathetic nervous system. So maybe he did have less less breaks on his inflammatory response and maybe that inflammation either from the underlying cause which we don't know what it was and never got diagnosed or from the uncontrolled inflammation that he experienced as a result of his depression.

Maybe maybe that causes cancer. So it's I'm not evading your question. I am I am adding a layer of understanding that it's more complicated than these oneoff things that you see so many times on these self-help pages. self-help pages. self-help pages. If it look, I've met people with serious um rheumatoid arthritis and I keep talking about that because that's what the FDA label says for the new device. I've met people with serious rheumatoid arthritis who are fit, who are healthy, who work out like you do, are very aggressive and and careful about what they eat and about their weight management and about their meditation strategies and and they still have severe rheumatoid arthritis.

Is is that is that their fault that they not exercising? And no, of course not. It might be that the that their vag nerve circuits are dysfunctional that they are broken and that could have been the case in your dad. He may have had a perfectly healthy brain, but maybe his vag nerve got trashed along the way. And and we saw that in CO, I don't know if you saw this, but in uh COVID victims were studied at autopsy in in I believe it was in Madrid, Spain.

I mean, this got huge news coverage when it came out, but their Vegas many of the vag nerves in the deceased were severely injured and many of the Vegas nerves in the deceased had the virus in the nerve. And so then since then a number of studies have looked using fMRIs and ultrasound imaging at COVID survivors who had longhaul COVID or have long haul COVID and they show evidence of damage in their vag nerve. So now the question is does the vag nerve damage preede the inflammation which precedes the problems in the cancer.

So I don't have all the answers but those are the right questions. I love when I have a doctor on the show who doesn't think he has all the answers. And I am I've been concerned over the last eight or 10 years when I have them on and they have every answer. Um because now they don't have any curiosity and uh they're dogmatic. And so I really appreciate your approach. Is there any practice every day by the way and you can reply to that. Is there a practice every day like you just won't skip as you answer what I just said too?

I mean, please don't don't feel obligated to do that first, but go ahead and reply to that. And then also like is there something daily like, hey, this is something every day I do, period. Well, I I really appreciate your your your comments on dogma and there there is a danger in medicine and science and and frankly, you know, whether you agree with what's going on everywhere in in politics today or don't, most people have one position or the other. There is obvious to me there is a push back now against academic dogma as providing all the answers all the time and there there's some of those reasons are are not warranted but some of them actually are and I think it it's really important when when we don't have all the answers that we we say this is what we know for sure this is what we are pretty sure is false and this is what we should be studying and as you know in I I I wrote the book one of the reasons I wrote the book was to sort of have that be a message of hope and a call to action.

You you really I I really want my colleagues to double down on some of these questions that you've raised in this podcast because if we double down on what the questions are, then we can figure out how to find out new answers. And that's what that's what we want, right? That's what that's what everybody wants. You asked about my uh daily habits. I mean, yes, I do I do what what grandma said and what you know your doctor and what you you say on the show.

I I try to watch what I eat. I try to eat a balanced diet. It it it's it's difficult to eat a balanced diet. I frankly find it easier to just avoid carbs and eat and eat protein where I can get it and as many vegetables as I can. I try to exercise regularly. Um try to get in um some different forms of exercise some some aerobic some uh uh yoga or stretching andor stretching and and some some strength and isometric. I think all those are important.

I think Peter Aia has written written brilliantly about this and and I think he gives very sage careful advice for people of all ages. I try to get enough rest. I definitely try to get my seven or eight hours sleep. I think that's really important. I don't monitor my rest with a with a wearable because I every person I've ever met who uses a wearable to monitor their sleep wakes up to check their wearable and I exactly right by the way it's actually it's also the first thing I do when I wake up it then I pray but it's not until I check my aura ring which is insane.

So insane. So insane. So I try to uh I try to avoid too much uh stress in my life. I try to take a stoic approach and focus on the things that I can control and you know accept the things that I can't control and I try to stay uh socially engaged with with people that that that I love and communities I care about and I try to give back to the world. I mean the the classic things that as I said grandma and hopefully your your your primary care physician is is teaching everybody else to do.

It's interesting to me that all of those things tend to slow your heart rate, you know, and so maybe maybe maybe we're slowing inflammation in the body. And at that point, it really is a Pascal's wager for me, you know. I do the cold showers, too. We talked about that. And I I don't mind doing those things. They might be good for me. If I'm on my deathbed and I find out that it was no use whatsoever, well, you know, I did my best. And and if I live to be 120 and I'm healthy, well, that'll be good, too.

You know, I look at it like, by the way, I'm teaching myself to do hard things. At a minimum, I'm getting that benefit of building some grit. And if there's some internal benefit, which I my hallucination is there probably is, then that's a bonus. But I'm doing difficult things. things. things. There's pretty good evidence for parts of the brain that light up on brain scans only when you do something you don't want to do that's good for you. Y. And so that strengthening of grit is being studied at the level of brain neurons.

And that's interesting, too. And I I agree with you. For me, it's stepping in that stupid cold shower. Same here, brother. That's mine. And I don't like it. And I've never adapted to it. So, by the way, guys, I don't want to lose this idea of when you're getting the book. I mean, just so you know, the book is fascinating. And just realize like I don't want to bury the lead. I mean, he was a founder of a company that just recently is now putting chips inside of people that is stimulating the vagus nerve.

And the potential for what that could mean for inflammation in the body and the reduction of disease potentially in the world is absolutely it's massive. And you all hear about this AI revolution that's happening. This is one of the applications and implications of it. And I want to make sure the lead isn't buried. That this is this is a time this man earlier in the show and now that you've heard him, this is not a dogmatic opinionated person, you know, just rigid in his ideology. He said earlier in the show that he thinks the potential for electricity in the body and the stimulation of it to replace or at least reduce the need for pharmaceuticals.

That's a pretty bold statement and it's a significant time we're going to be living through. So, um, I want to ask you one last question because I teased it earlier and I at least want to have it there for conversation, which is this idea of heart and brain coherence. I just want you to uh we'll finish with that and then I'll I'll talk about the book for a second when we finish, but what is that? Dispensza talks about it, my buddy who's been on many times, and what are the implications and why is it relevant in your opinion if at all?

It's relevant in the context of larger picture of health which which is homeostasis. So what is homeostasis? Homeostasis is a balanced functioning of your organs. So your your your kidneys are making the right amount of urine. Your heart's beating at the right pace to support your blood pressure. Your blood pressure is not too high, not too low. Homeostasis is when all of your organs are operating in a Goldilocks uh not too much um not too little kind of output. that is all controlled uh second to second millisecond by millisecond actually by reflex signals traveling in mostly in your vagus nerve and in your sympathetic nerves.

So if you think about that for a minute it's kind of mindboggling. I mean you can separate in in uh various experimental models and and even in some pharmacological ones you can separate the function of sort of your thinking human brain from the brain that's operating all day long to control these these reflexes. And when you look at the output of those organs, the beauty of it uh is that it's not railroad ties boom boom boom boom boom. its waves. its waves. its waves. So the the harmony between the organs, if you were to measure each organ as having its own output and you do that electrically, what you see looks like a symphony, symphony, symphony, not banging a gong.

In fact, if you see a banging gong, and I can direct you to a place where you could see it this afternoon, uh it would be in the ICU of a hospital. So when people are critically ill, say they've had sepsis for a long period of time, uh, and they're the and they're very very sick, the their heart their heart rate doesn't heart rate their heart rate doesn't vary. It's beat be beat and the outputs of the other organs doesn't vary. It beats with the heartbeat.

Everything's in lock step. It's almost it's the opposite of a symph of a symphony. It's a banging of a gong. And so I don't think we fully understand what that means, but but it points to the importance of the of synchronization of harmony between not only the brain and the heart, but the brain and every other organ. And the heart the heart's fun to measure because you can check your pulse and you can do an EKG and you can check your blood pressure uh and you and you can experiment on and you can experiment on yourself and it and it's great.

But when you apply the same basic teachings to the other organs, it's fascinating. So we're in my lab now. It's the hottest project in my lab now, which we got a whole bunch of people working on it. And we're actually studying the flow of information that's going from the organs in the body up the vagus nerve into the brain. And we're we're hacking into the Vegas nerve uh signals like uh submariners would hack into a transatlantic cable so they could watch a movie on the wall of the submarine by tapping into the cable.

We're we're learning how to tap into the Vegas nerve to understand what these signals mean and how they work. But the harmony the harmony is the key. Harmony is the key thing. People call the Vegas nerve a super highway. It's not. It's not. I never I never use that description. a traffic traffic is boring. And the signals in in the in the Vegas nerve are much more beautiful and and and and harmonious. They're like the they're like the strings of 30 violins all sort of playing in harmony.

And that's what health is. health is. health is. You guys, this is such a a great time to be alive. And we we may all have a chance of living a lot healthier and a lot longer here real soon. By the way, that lab, is it Feinstein or Feinstein? Feinstein Institutes at Northwell Health. Health. Health. Here you go, you guys. And the book everybody is for the fifth time is The Great Nerve by Dr. Kevin Tracy. And I think you could tell today there's a lot in this book.

There's no wasted pages. Every page is interesting. You're going to learn something. And I know you did today, guys. You guys want to have them back on? I can hear you yelling in your car right now. Yes. They're on their treadmills yelling. So, we're going to have you back. We'll we'll take a little breather for a while, but we're gonna have you back and unpack a bunch more stuff together. Okay. I look forward to that. And I I want to thank you for your preparation and your insights to this.

This has been a real pleasure talking to you and and thank you uh for having me out. Been my honor, brother. All right. God bless you everybody. Share this episode. You need to share this one. Max out your life. Take care.