The Healing Power of the Vagus Nerve in Brain Disorders & Complex Chronic Illness

Whirling Dervishes (Accessing Their Vagus Nerves) Cut paper, ink and acrylic on wood panel by Courtney Snyder

Courtney Snyder, MD

The proper functioning of the vagus is one of the most important determinants of physical and mental health, social communication, compassion and even creativity.  If you have a psychiatric condition or a complex chronic illness (or your child does), understanding the vagus may help demystify what has likely been a confusing and demoralizing experience. In this post, I'll discuss the many roles of the vagus nerve, the many body systems it influences, and the many seemingly unrelated symptoms it can impact when it’s not working well.  My hope is that the vagus will become as awe inspiring for you, as it has for me, and that you’ll want to help it help you. 

There are many ways to improve vagal "tone" to access healing and well-being. Perhaps because they're fun and life affirming, they’re often not taken seriously. In my own journey, I spent years trying to dominate my biochemistry, improve my microbiome and avoid  and  remove toxins. This narrow attention held me (and my daughter) back. If this is where you’re at, then I write this for you.

SAFETY
Before we get to the science and strategies, know that the vagus is all about safety. You may be thinking, “I feel safe.”  We don't face animal predators or an enemy tribe, like your ancestors, but we still experience threat.  It may be a family conflict, a toxic workplace, the evening news, a political facebook post, a honking driver or the tone of someone’s voice. The threat may be recalling what we said or didn’t say, or imagining we'll lose our train of thought in a presentation. It may be the endless chatter of what we have to do. If we experienced early life adversity or abuse, the threat may be a type of person or even people in general. It may be a smell or a sound related to an event we don't consciously remember.  For those with complex chronic illness, random, frightening and confusing symptoms can lead some of us to experience our own body as the threat.  

Other threats our body perceives, that our thinking brain may not, are microbes (candida, mold, virus including COVID 19, lyme, etc) and/or toxins from microbes.  There are also the toxins we can accumulate from the outside (such as metal, chemical, and mold toxins) or a soup of all of our toxic exposures.  We come into the world with a level of toxicity and we have a threshold that when reached alarms our body. How quickly this happens, if at all, depends on the amount of exposure and how robust our inherent ability to detoxify is.

We can simplify our activities, relationships, items and exposures to those that support our wellbeing.  In these times, we can bolster our ability to detoxify.  Still, modern life will be more stressful and toxic than our bodies were designed for. Our stress response was meant for infrequent threats, not daily living. The consequences of this chronic stress include a cascade of stress hormones, inflammation (the immune system's responses to threat) and the expression of certain genes, all of which lead to disease.

INADEQUATE OR DISRUPTED ATTACHMENT & EMOTIONAL TRAUMA & TOXICITY
Neurological pathways of chronic stress can be laid down during early childhood or even later in life through trauma, repeated trauma, repeatedly recalling a traumatic event or even chronic health issues. It is well known that those with early childhood adversity are more at risk of disease later in life. This is likely because of overly developed neurologic wiring for survival.  Even when out of harm's way the body doesn't feel safe.  Similarly, people with high levels of toxicity often don't feel safe, even if they don't know why.  
 
This type of trauma and/or toxicity can lead to sensitization - a phenomenon in which the stress centers in the midbrain (not the thinking cortex) are essentially staying on and reducing the functioning of the vagus nerve.  Likely most of us with complex chronic illness or psychiatric conditions were born "wired for danger," due to a mutation in a gene involved in stress hormone pathways as is argued by Dr. Sharon Meglathery's RCCX theory.  But, just as our collection of genes isn't our destiny, neither is our wiring. 

NEUROPLASTICITY
Our nervous system is more malleable than we might think. With the help of the vagus nerve, we can repeatedly give our body and brain the experience of feeling safe. The magic of neuroplasticity is that we are constantly forming new neural pathways and the more we have an experience, the more new pathways are reinforced. If we're chronically thinking and talking about our problems or our symptoms, we're further reinforcing pathways of defense. I can assure you, I have done plenty of this myself. My friends and family would agree. Instead, we can choose to chronically think about what we’re grateful for (even when it’s not easy) and we can chronically help our body feel safe (with the tools I’ll get to below). 

THE BRAKE
Think of the vagus as the brake we can use when we need to decrease our physiologic reaction to stress. And know that we can fine tune that brake and have it working so well that it starts to mitigate our body’s response - even before we realize we’re under stress. It allows us to become exceedingly resilient and able to bounce back to a calm state quickly. If that weren’t enough, an ability to self regulate allows us (without conscious intent) to bring calm to those around us. 

SOCIAL COMMUNICATION
We receive input about the safety of others and our environment through our eyes and ears. Without conscious thought, this information is influenced by the vagus. The vagus sends information to our organ systems as well as the muscles of our head and neck.

Many individuals with autism are dealing with high levels of toxicity in their body, as are most people with brain related symptoms. Toxicity is a constant “threat.” When we’re in danger, our body mobilizes to defend us, not to prepare us to hang out with friends. Those with autism often have severe sensory issues (to loud noises, bright lights, etc) as well as severe deficits in social communication as evidenced by lack of eye contact, the way they speak and even the way they hold their head. These sensory issues and deficits in social communication are all influenced by cranial nerves which are influenced by the vagus nerve. If you’ve ever had depression or even the flu, it may have been hard to look at or listen to others. “Get out of my face,” may have been what your body was communicating. This particular physiological stress response involves immobilization - a shutting down or withdrawing, as opposed to the well known flight or fight response.

ANCIENT UNDERSTANDING
There’s evidence that ancient cultures not only recognized the importance of the vagus nerve, they revered it. Anatomically, this large nerve would have been hard to miss. It’s the longest cranial nerve in the body, going from the lower part of the brain, down the neck all the way down into the abdomen with many offshoots along the way. Vagus means wandering in Latin. Ancient rituals which have carried into contemporary religious and/or spiritual practices such as chanting, praying, meditation, dance and posture shifts such as kneeling and falling prostrate would have exercised vagal pathways and resulted in a calm and compassionate mindset.

While our ancient ancestors were embodied, we tend to be “in our heads” analyzing, reasoning, calculating and judging. For many of us, our body is something to make look better, work better, or to get us what our ego wants. We outsource experiences like singing and dancing to a very few. Thoughts of these or even of meditating can trigger a stress response. Growing research (which our ancestors would laugh at, but of course we need) into the impact of meditation, yoga, singing, dance and breathing practices are proving that when it comes to lowering the stress response and thus healing from disease, the body and not the mind is where it’s at.

CALM, CONNECTION, COMPASSION & CONTAGION
Only when we feel safe and trust that we’re okay (which in these times takes practice) are we able to grow and repair physiologically, to tap into our higher/greater selves, create, engage with others and feel compassion. When our bodies perceive a threat, our physiology goes to survival - fight of flight (anger or panic) or shutting us down as described above. Such states are not conducive to connecting with others nor to recognizing their needs or suffering. Many of those who are insensitive to the experiences of others, live in a chronic survival mode.

Whether we intend it or not, our sense of threat or our sense of safety is conveyed by our facial expression and the tone of our voice. Depending on how self aware those around us are, they may take their own unconscious physiologic stress response onto their next encounter. Or, they may take what their body is telling them all the way up to the reasoning part of the brain, observe what is happening, and stop the contagion. We all have the choice to self observe, set emotional boundaries and know that we don’t have to take on threats of those around us (unless the house is on fire).

First some DEFINITIONS (simplified) to put the vagus in perspective:

Central Nervous System:

• Brain
  • ​​Cerebrum -  where we think and learn. Also involved in emotions, planned muscle movements, and our senses.
  • Brainstem - bottom of the brain, connects cerebrum to spinal cord and controls fundamental body functions such as breathing, eye movements, blood pressure, heartbeat, and swallowing.
  • Cerebellum -  controls balance, coordination and fine muscle control 
• Spinal cord - sends messages between the brain and the rest of the body (in both directions).

There's a lot going on below the thinking part of our brain that's impacting our emotions and how safe and secure we feel in the world.

Autonomic Nervous System - controls automatic functions that happen beyond the brain’s conscious awareness. Starts in the brainstem and spinal cord.  There are 3 parts:

• Sympathetic Nervous System -  Activated when we’re under threat to prepare our bodies for FIGHT (anger) or FLIGHT (“get me out of here”) by moving blood to the heart and muscles (to help us move fast) and away from the digestive tract.
  • Constrict blood vessels to move blood to needed areas
  • ​Increased heart rate (“my heart was about to jump out of my chest”)
  • Decrease blood flow to the gut (“butterflies in my stomach”)
  • Decrease intestinal activity ("knot in my stomach")
  • Increase respiratory rate (“can’t catch my breath”)
  • Dilate bronchioles - so more oxygen can reach needed muscles
  • Activate Immune system  (aka inflammation) - so you can survive the potential or pending trauma or infection.

• Parasympathetic Nervous System- The BRAKE on the sympathetic nervous system that allows us to REST and DIGEST. The VAGUS is the main component.
  • Dilate blood vessels
  • ​Decrease heart rate
  • Increase blood flow to the gut
  • Increase gastrointestinal activity 
  • Decrease respiratory rate

In this parasympathetic state, the body is able to repair itself and grow, but also to feel calm, socially engage, feel compassion and create.

• The Enteric Nervous System - “Second brain”
  • a mesh-like system of neurons that connects to the sympathetic and parasympathetic nervous systems (and is how they these systems influence the GI/gastrointestinal tract)
  • appears to be the way digestive organs communicate to coordinate digestion
  • produces more than 30 neurotransmitters
  • ​the way the microbiome (the trillions of microbes in the gut) communicates with the brain through the vagus nerve and through hormones and peptides it releases into the blood which cross the blood brain barrier.  Together these influence when we feel full, our appetite, mood and our inflammatory response.

And now you generally understand what is meant by the ….

• “Gut-Brain Axis/Connection” -
  • ​the BIDIRECTIONAL communication between the brain and GI tract (connects emotional and cognitive areas of brain with gut functions).
  • involves:
    • Enteric nervous system
    • Sympathetic nervous system
    • Parasympathetic (via the vagus nerve) nervous system
    • Hormones
    • Immune cells including mast cells
    • Microbiome

VAGUS NERVE - Finally!
The main component of the parasympathetic nervous system.

• Cranial nerve 10 (There are 12. The others are responsible for much of the sensory and muscles of our head and neck)
• Actually a pair of nerves that emerge from the left and right side of the lower half of the brain stem before wandering down the neck and into the chest
• Supplies motor parasympathetic fibers via branches to all the organs except the adrenal glands, from the neck down to part of the large intestine. 
  • Carries output (ie. information to other parts of the body)
  • Carries input (brings information about the state of the organs back to the brain)
• POLYVAGAL THEORY by Dr. Stephen Porges emphasizes that there are actually 2 separate nerves/branches coming from 2 separate areas of the brain that fuse together to become the vagus. The DORSAL aspect relates to the shut down/freeze/immobilization response (again, a third defense mechanism that is different from fight or flight)…..and the ventral aspect which is especially important in social communication.

Dorsal Vagus

• Over activated when we face overwhelming stress where fighting or fleeing aren’t options. Instead our body conserves resources (blood flow) and immobilizes, freezes or shuts down. Imagine the animal that feigns death (reflexively) when they are about to be killed by a larger animal (seeking fresh meat).
• Extreme danger, traumatic events - real, imagined or remembered - can cause this dorsal vagal response or shut down. (I would argue that significant toxicity can contribute to this as well)
• Physical responses include:
  • ​nausea and sweating
  • fainting
  • loss of bladder and anal-sphincter control
  • ​slow shallow breathing
  • Postural Orthostatic Tachycardia Syndrome (POTS) which involves lightheadedness, fainting, and rapid heart rate triggered by standing up after laying down. 
• Psychiatric symptoms:
  • dissociation - becoming disconnected from your current environment
  • depersonalization or derealization - feeling outside of oneself or feeling the environment isn’t real.
  • depressive-like behaviors (seemingly a more chronic dorsal state of immobilization) - loss of appetite, decreased energy, apathy, social withdrawal, helplessness, hopelessness, and problems concentrating.

Ventral Vagus

• A newer circuit that is also called the myelinated vagus
• Related to feeling safe and supports the ability to socially engage, create, feel compassion

THE MANY ROLES OF THE VAGUS NERVE:

• PEACEMAKER
  • Releases the neurotransmitter acetylcholine which counteracts the effects of adrenaline from the sympathetic or fight or flight response and tells our body to relax

• OVERSEER of Bodily Functions
  • Digestion -
    • ​carries bidirectional communication between the brain and GI tract
    • responsible for all things digestive from the end of the esophagus to part of the colon
    • salivation - needed for breakdown and taste of food
    • swallowing (by influence on one of the other cranial nerves)
    • involved in the gag reflex
    • gastrointestinal peristalsis/motility - from stomach to large intestine keeping us from getting constipated
    • involved in vomiting
    • gastric emptying
    • gallbladder and pancreatic functioning - we need bile secreted from gallbladder and digestive enzymes secreted from the pancreas to help us break down fats, proteins, and carbohydrates
    • decreases intestinal permeability and thus our vulnerability to “leaky gut” and all of its consequences including immune responses to food particles that make their way through the gut lining and into the bloodstream
    • controls blood sugar by way of fibers that inhibits liver gluconeogenesis (the generation of glucose from molecules that aren’t sugar) and thereby keeps our blood sugar from becoming elevated (this can have a number of consequences, including feeding microbes such as yeast and mold)
    • impacts the microbiome by its impact on the ph (beyond the stomach)
    • impact on gut immune function (more on this below)
    • As you can see, if sphincters aren’t working properly, ph is altered, food isn’t well digested, blood sugar is high, the microbiome is out of sorts and the bowels aren’t moving well, then problems like SIBO, candida, leaky gut, food sensitivities, Irritable Bowel Syndrome and/or Inflammatory Bowel disease become more likely
  • Cardiovascular
    • the right vagus is more likely to carry fibers that supply nerves to the heart
    • regulates heart rate - activation leads to decreased heart rate
    • regulates blood pressure and the constriction and dilation of blood vessels
    • excessive activation (likely through the dorsal aspect of the vagus) could cause a sudden drop in cardiac output and secondary decrease in blood to the brain (e.g. fainting)
  • Respiratory
    • keeps the larynx open for breathing
    • decreases respiratory rate
    • constricts bronchi
    • regulates coughing & sneezing
  • Sweating

• ACTIVIST against inflammation
  • Influences our immune response - preventing inflammation throughout the body
  • Counteracts the fight or flight response which is inflammatory
  • Prevents the increase in the production of cytokines/inflammatory mediators by mast cells that influence various parts of the body including the brain. While there are ways to stabilize mast cells, accessing the vagus nerve is extremely important.
  • Increasing vagal tone will inhibit cytokine production.

• FILTER of sensory input
  • Despite all that influence on our organs and even the motor nerves of the head (which I’ll get to), 80-90% of the nerve fibers in the vagus are sensory meaning they bring information from the organs and even other cranial nerves (of the head and neck) and take that information to areas of the lower (not thinking part) of the brain
  • Tells us if our stomach is full (another way it can influence our weight)
  • ​​Tells us what’s going on with the microbiome in the GI tract
  • Sensory information from our eyes, ears (including inner ear which is important for balance), mouth and nose. This is because of its connection to other cranial nerves.
    • Nociception - relates to how neural pathways of the autonomic nervous system evaluates information from our senses about our environment and the state of our body to determine if a situation is safe or dangerous. This is what is meant by "listening to your body. "  You might also call this intuition or your "sixth sense" - a knowing that exists outside the thinking part of our brain.
      • Example -  We feel safe in our bodies when we are with people with warm expressive faces and a calm tone and appropriate tone and fluctuations in their voice.  Our eyes and ears (by way of the vagus), are better at picking up on a fake smile (by the person’s eyes) or an incongruent tone of voice than the reasoning part of your brain which is looking at the mouth and listening to the words. 
  • Sensory Issues - Impairment in vagal nerve functioning can also be at play for those with “sensory issues,” seemingly because of how the vagus influences the incoming information from those nerves.
    • Hearing (cranial nerve for hearing) - ie. can’t tolerate loud sounds, difficulty processing what someone is saying (especially when there are other noises)
    • Balance (cranial nerve for inner ear) - ie. problems with balance and vertigo.
      • There is evidence that vagal circuitry is interconnected with the vestibular system, (and why non-invasive vagus nerve stimulation, discussed later alleviates vertigo in vestibular migraines)
    • Vision (cranial nerve for the retina) - sensitivity to bright lights
    • Smell (cranial nerve for the olfactory nerve)- especially bothered by certain smells
    • Taste (another cranial nerve involved in taste) This may be the means by which problematic gut microbes (such as yeast) influence the taste of certain foods  - thus increasing the likelihood that they will be fed with high carbohydrate foods.
• INFLUENCER of social communication
  • By way of its strong influence on other cranial nerves that control muscles of the neck, throat, ”voice box,” mouth, eyes and ears.
    • Speech
    • ​​Laughing
    • Singing
    • Ability to visually track (as in reading) and easily make eye contact

CAUSES OF AUTONOMIC DYSFUNCTION/LOW VAGAL TONE:

• Emotional - Anything that leads you to be in a chronic state of emotional stress
  • attachment disruption or insecure attachment
    • much of our wiring is laid down during our first 3 years of life. What we may not “explicitly” remember, our bodies can “implicitly” remember.
  • early childhood adversity
  • emotional trauma
  • chronic stress
• Physiologic - Anything that leads to a chronic state of physiological stress
  • infections or microbial overgrowths - bacteria, virus, yeast, mold, abscess (ie. tooth abscess), etc.
  • toxicity such as mold toxicity (or other biotoxins)
• Structural
  • ​​Damage to the nerve itself
    • damage from toxins
    • from alcohol or diabetes
    • from surgery or other trauma
  • Issues involving neck and/or skull
    • upper cervical instability (the vertebral bones of the neck moving more than they should) which can impact the natural curve of the neck causing the vagus to be stretched which can disrupt nerve signaling. This can be due to:
      • Injury (obvious whiplash or less obvious repeated trauma from tumbling or contact sports) 
      • Joint laxity for those joint hypermobility as in Elhers Danlos or in those who are especially flexible 
    • ​​​scar tissue impinging on the vagus or adhesions (scaring down) of the vagus nerve from a previous injury
    • decreased cranial compliance due to injury (we should have a degree of give to the joints of our skull)
    • excessive time sitting at computer, can impact interfere with functioning of the vagus by way poor posture (with chin forward), shallow breathing and lack of movement
  • Mouth
    • tooth extraction or braces - can cause a chronic sympathetic stimulation or dorsal vagal state (Rosenberg)
    • misalignment of the jaw
    • tongue tie - which reduces the overall movement of the tongue resulting in low vagal nerve stimulation. This can look like fight of flight due to lack of stimulation of the the cranial nerve that supplies the muscles to the tongue.
    • mouth breathing - again results in low vagal nerve stimulation. When we correctly breathe through our nose, our tongue is on the roof of our mouth. This and correct swallowing stimulates nerves of our tongue and the vagus.
• ​Combination of emotional, physiologic and structural causes 

SYMPTOMS THAT CAN POINT TO VAGAL NERVE DYSFUNCTION

• Cranial nerve dysfunction (the vagus itself or symptoms related to those cranial nerves that the vagus can influence)
  • Uvula (tissue hanging down in the back of the mouth) not staying centered when you say “ah.” The palate should elevate symmetrically.
  • Lack of gag reflex
  • Hoarseness
  • Problems swallowing
  • Aspiration (unintentionally getting food or liquid into windpipe)
  • Ringing in ears/tinnitus - if vagus nerve is impacting the cochlear nerve.
  • Vertigo - can be measured by having someone stand with eyes closed and seeing if they sway.
  • Clenching of teeth/TMJ - has been linked to high sympathetic tone (and thus lack of the parasympathetic brake)
  • Problems with social communication - difficulty using your neck, eyes, hearing and speech to connect with another person. Deficits here could look like turning away, lack of eye contact, absence of speech or mechanical sounding speech.
  • Sensory processing issues likely as well (sensitivity to bright light, loud sounds, certain odors) (See link below)
• Muscle tone
  • too hard (sympathetic) or too soft (dorsal vagal circuit is activated), just right (ventral vagal). An example of a high sympathetic tone in a child may be toe walking.
  • Handshake - too tight (sympathetic), too limp, damp or cold (dorsal) Rosenberg
• Gastrointestinal Symptoms
  • ​constipation, bloating, SIBO, candida, leaky gut, food sensitivities, Irritable Bowel Syndrome and/or Inflammatory Bowel disease.
• Cardiovascular
  • ​Low blood pressure (heart rate too low) or too high
  • Postural Orthostatic Tachycardia Syndrome - as described above
• Chronic inflammation
  • in the form of mast cell activation, systemic inflammation and autoimmune conditions
• Psychiatric symptoms
  • ​​​Anxiety, panic, depression, dissociation, depersonalization and derealization

ASSESSING VAGAL TONE
When we feel safe and our autonomic nervous system is working optimally, there is a slight activation of our sympathetic nervous system on inhalation which causes our heart to beat a little faster. When we exhale, the parasympathetic nervous system causes our heart rate to decrease. The difference in these two heart rates is referred to as heart rate variability.

Heart Rate Variability:

• how vagal tone is measured
• high heart rate variability = high vagal tone (this is what we want)
• ​considered a measure of
  • how well we are balancing our emotional lives.
  • flexibility of our heart and nervous system (which reflects our health and fitness)
• low heart rate variability (which can be improved upon) is - 
  • associated with a number of medical conditions
  • a predictor of future health problems including obesity, high blood pressure, heart disease.  There is evidence that it can predict cancer, cancer metastasis and the mortality of people with cancer.
  • decreases with age

There are devices available to measure heart rate variability, including chest straps. I use an earlobe sensor along with the Inner Balance App from Heart Math.

IMPROVING THE TONE OF THE VAGUS NERVE
aka - accessing the vagus nerve or “balancing the autonomic nervous system"
When you increase vagal tone, you are activating the parasympathetic nervous system. The more you do this, as with anything, the more easily you can do it without great effort. This means relaxing faster when under stress and optimizing all of those systems already mentioned. As you can see, this is bidirectional - high vagal tone leads to improved physical and mental health and better physical and mental leads to better vagal tone.

• Passive - don’t require conscious awareness
  • ​Put your body in a safe space - as one might do when meditating, praying or engaging in other contemplative practices. This means removing yourself from things, people and spaces that can lead to stressful thoughts which stimulate your sympathetic nervous system.  
  • Meditation is one example. Because your eyes are closed, you don't have reminders, for example, of 'that thing you need to do'.   If sitting quietly and not having stressful thoughts sounds stressful,  consider guided meditations which help gradually shift your attention from convergent (narrow) attention to divergent (open) attention which slows brain waves and calms the body.  My own preference currently are the morning and evening meditations by Dr. Joe Dispenza.  
  • Be with safe people with whom you have positive social interactions. This improves vagal tone (and improves mood) in a number of ways
    • All neural pathways of social engagement are being used - your neck, mouth, face, middle ear, voice-box and throat.
      • When you turn or lift your head to look at someone (accessory nerve), look into their eyes (optic nerve) listen to them (cochlear nerve) and then speak back (vagus nerve) while modulation of your voice (again cochlear nerve) or better yet, laugh (vagus) and make facial expressions and eye contact (oculomotor), you are accessing the vagus and many of the nerves it influences. Collectively, this down regulates sympathetic pathways.
    • Safety is key - if you feel threatened by that person, your sympathetic nervous system will predominate - if not outwardly with anger or fleeing, then inwardly through the physiological stress response
    • Social distancing due to COVID is undoubtedly having profound effects on our collective mental and physical health for these reasons (unless it allows those of us who don't live alone to be more present with those with live with). It is unknown how videoconferencing (Zoom) compares to face to face in these regards. An intention to connect, the act of looking at a trusting person’s face, hearing their voice, talking to them and making facial expressions are all impactful, likely there are subtleties and even unseen energy missing in these types of interactions.
• ​Active - conscious behaviors that trigger specific neural mechanism that in turn, change one’s physiologic state
  • Simple deep breathing
    • Breathe deeply from diaphragm so that stomach expands out. This lowers the diaphragm which pushes downward and influences the vagal outflow of the heart. Exhale slowly
    • Even 3 deep breaths can interrupt the fight or flight response​
  • ​​​Singing or Chanting or Humming
    • Like breathing exercises, singing requires extended exhalation relative to inhalation.  But here, you're also monitoring sounds. The vagus is connected to the muscles at the back of the throat and vocal cords. You may have seen Kodi Lee, a young man who is blind and has autism, on American Idol. When he is singing which he does beautifully, you wouldn't know he has autism, however when he's not, his social communication issues are more evident.  Similarly stuttering or tic like behaviors can cease when someone is singing.
    • Humming and gargling can also access the vagus nerve.
  • ​Postural shifts
    • Dance or other movement
      • If this sounds daunting, start with turning on some music at your desk. Even if you have low energy or even pain, there are ways to start to move to music.
      • ​​There is a TED talk by Frederico Bitti who had a movement disorder called cervical dystonia.  He discovered that when he danced, his symptoms remitted. This became his therapy. (His talk shows him with his symptoms and without while dancing).
    • Yoga - which also incorporates attention to breathing 
    • Contemplative practices which involve postural changes, such as kneeling, seem to access vagal tone and thus down regulate defense. This happens by way of baroreceptors in arteries which pick up on pressure changes created by postural changes. What we’ve assumed is a show of reverence for a higher power, may have been, at least in part, a means to physiologically access another state of mind and body.  (Porges)
  • ​Cold treatment 
    • Exposing yourself to cold on a regular basis to increase parasympathetic activity
    • This might look like:
      • ​finishing showers with cold water
      • putting face into ice cold water
      • stepping outside momentarily into the cold

While cold treatment isn't how I like to access calm, dancing, singing and meditation are.  For years, I longed to sing and dance.  While my body knew what it needed, my under-methylated mind couldn't justify spending time on such activities. This past year, I committed to make these part of my life. I awkwardly started dancing each morning to exercise videos.  My movements became more awkward each time my husband or daughter walked through the living room.  I persisted. Aside from accessing the vagus, I was gradually rewiring a part of my brain that had been dormant since childhood.  Now I find myself happily dancing without thinking and at unexpected times through the day.  My daily practices also include a morning and evening meditation.  It's an especially good day, when I make time to sing.

• Tools one can do on their own or with assistance
  • Stanley Rosenberg’s book  - "Accessing the Power of the Vagus Nerve: Self-Help Exercises for Anxiety, Depression, Trauma, and Autism" - has exercises involving the cranial nerves that take about 10 minutes a day.
  • Massage
    Can stimulate the vagus nerve and increase vagal tone. Foot massage, specifically has been shown to increase vagal tone and increase heart rate variability and decrease the fight or flight sympathetic response.
  • Tapping / EFT /Emotional Freedom Technique - tapping on particular parts of the face and upper body while cognitively identifying the thought that is creating the stress response, recognizing the feeling in the body and essentially changing the narrative - changing the story that you are telling yourself. This is much easier when our bodies are calm which is what tapping and other interventions do.
  ​Others that require professional involvement
  • Frequency Specific Microcurrent (FSM).  FSM has the potential to access the vagus nerve directly.  It has also been used to address structural issues impacting the vagus such as adhesions and many downstream effects of vagal nerve dysfunction.
  • Surgically implanted devices approved by the FDA that periodically stimulate the vagus nerve. There are also non invasive vagal nerve stimulators.  (Though I am trained in the use of FSM, I don't have experience with vagal nerve stimulators).  They have been used and/or are being studied in refractory epilepsy, depression, PTSD, inflammatory bowel disease, Rheumatoid arthritis, cluster and migraines, obesity, Bipolar Disorder and Alzheimers. They have been shown to cause weight loss in those with epilepsy or depression.  Accessing the vagus nerve in other ways would be expected to have similar effects.
  • Addressing structural issues affecting the vagus such as cervical instability, tongue tie, etc. with appropriate specialists.
  ​Healthy Gut Bacteria
  • Because of the bidirectional nature of the vagus nerve, a healthy microbiome is key. While there’s growing evidence that gut bacteria improves mood and lowers anxiety by affecting the activity of the vagus, you’ve probably done your own research. When you’re eating sugar and carbs, you likely feel more stressed and irritable.  This is likely due to problematic microbes thriving on sugar and carbs. The more there are, the more toxins our body is perceiving as a threat and the more our sympathetic (fight or flight) system is working and our parasympathetic (vagus) is not.  When you’re "eating clean," you're likely more calm and and more patient with those around you. 

STILL WANT TO USE YOUR BRAIN?
If after all of the above, you still insist on using your thinking brain, then use it to make a habit of sitting yourself down in a quiet space and exercising your vagus nerve. Your ability to access calm is always with you.  Practice and you will become less reactive physically and emotionally and when you do become stressed, you'll recover and return to balance more quickly. This takes time.

You can also use your brain to notice your physiologic state throughout the day. Is your body telling you to fight, or flee or did it just cause you to check out? Does it feel calm and safe? Did your neck just become tight? Do you feel like your heart rate picked up? Are you holding your breath or breathing faster?  Such awareness takes practice, especially in our disembodied culture.

When you do notice, THEN go to your brain and wonder, “What is my body trying to tell me?"  "Is there something I need to pay attention to or do something about ...or not?"  After noticing, then go back to your body, specifically your autonomic nervous system - the vagus, and with the help of one of the tools listed above, ask it to help you get back into equilibrium.

PRACTICE BEING YOUR OWN NURTURING CAREGIVER
A secure attachment with a “good enough” responsive caregiver in our early life is what allows us to have good emotional and physiologic regulation (even if this regulation is derailed by other events and exposures). The same holds true with our connection to our body.  A consistent tending to our need for safety is essential for healing and maintaining wellbeing.  If you’ve lived in a chronic state of stress, it takes practice to learn to self regulate and feel safe again or for the first time.  If you struggle with complex chronic illness such as chronic fatigue or fibromyalgia or a psychiatric condition, you could do everything perfectly (whatever that means to you) as far as diet, supplements, removing toxicity and sources of inflammation, and if you haven’t learned to access the vagus nerve, you may still struggle to heal and thrive.  

I hope I've given you reason to become that nurturing caregiver - the kind who repeatedly reminds your body that you are safe.  But even more, I hope I've given you a good reason to sing and dance.  

Further Resources  (click on links below)
Vagus Nerve as Modulator of the Brain–Gut Axis in Psychiatric and Inflammatory Disorders
The Polyvagal Theory: New insights into adaptive reactions of the autonomic nervous system
Ancient Rituals, Contemplative Practices, and Vagal Pathways - by Stephen Porges, PhD
Accessing the Healing Power of the Vagus Nerve: Self-Help Exercises for Anxiety, Depression, Trauma, and Autism - by Stanely Rosenberg
Parasympathetic Functions in Children with Sensory Processing Disorder 
Compression of the vagus nerve due to cervical instability