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 wellbeing. 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.
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.
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).
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.
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.
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:
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:
The main component of the parasympathetic nervous system.
THE MANY ROLES OF THE VAGUS NERVE:
CAUSES OF AUTONOMIC DYSFUNCTION/LOW VAGAL TONE:
SYMPTOMS THAT CAN POINT TO VAGAL NERVE DYSFUNCTION
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:
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.
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)
I'm a conventionally trained child, adolescent and adult psychiatrist. My current approach to health is both holistic (pertaining to the whole person) and functional (addressing the root causes of illness). I write this blog to share what I've learned.