For folks with symptoms ranging from fatigue to depression and anxiety, digestive issues from IBS to SIBO to IBD, to brain fog and even food sensitivities, the Vagus Nerve almost always plays an important role in both sickness and healing, and needs to be supported so you can truly and deeply heal.
What is the vagus nerve?
• Vagus means “wanderer” in Latin, and the vagus nerve wanders from the brain through most of the body.
• The vagus is the longest of the cranial nerves. It starts in the brain, where it sends signals to the cells there. It then wanders through the body, from the brain through the neck and throat to the heart and lungs. The vagus moves down to the gut and digestive organs - liver, pancreas, gallbladder - and all the way through to the kidneys and to the uterus.
• Signals are constantly flowing from the brain to the body and back from the body to the brain, via the vagus nerve.
• Vagus nerve “tone” is key, and activates the parasympathetic nervous system. The“rest and digest” system, and improved vagal tone supports your body and mind in relaxing faster after stress.
• Studies have shown that there is a positive feedback loop between vagus tone, optimal physical health and positive emotions. That is, the more you support your vagus nerve and improve tone, the better you’ll feel overall.
Think about a Technical Knockout (TKO) punch in boxing - it’s a straight shot to the vagus nerve. Because this nerve goes through most of the body and enervates, or gives nerve activity to, so much of the body, a strike to it knocks you out cold. The body is very protective of the vagus nerve. Any alteration in the normal, pre-programmed flow can lead to big changes downstream in the body.
Some folks with constipation or those with hard or large stools can experience body-wide symptoms resulting from pressure on the vagus nerve – cold sweats, anxiety, tingling in hands and feet, and more - all from a really hard stool! I had a patient once who would frequently literally pass out from a large, hard bowel movement. Which goes to show how much having the correct vagus signaling effects our bodies. (she’s better now, by the way. She had really intense methane SIBO, which we tested for, found and treated. No more unconsciousness on the bathroom floor, thank goodness)
Some common symptoms of Vagus Nerve Dysregulation:
• Irritable Bowel Syndrome (IBS)
• Small Intestine Bacterial Overgrowth (SIBO)
• Chronic Fatigue
• High or Low Heart Rate
• Difficulty Swallowing
• Insomnia or trouble sleeping
• Gasteroparesis, also known as delayed gastric emptying
• Heartburn, reflux, gastritis or GERD
• B12 Deficiency
• Chronic Inflammation
• Weight regulation issues (1)
Fight or Flight: Lion-Based Consciousness
There are two important nervous systems in our bodies: the sympathetic, or “fight or flight” and the parasympathetic or “rest and digest.”
The vagus nerve is part of the parasympathetic system. This is the system that supports us in chilling out, centering, calming ourselves, as well as digesting our food, having a healthy reproductive system, and healing.
Back in the day, humans had to keep a constant and vigilant eye out for lions. We had to hide from, run from, possibly fight, lose to and get eaten by, lions. Our bodies are pros at Lion-Based Consciousness. And when we’re on high alert for predators, our bodies are in "fight or flight" or sympathetic dominance. In that state, the vagus nerve is neither giving nor getting the signals it needs to do its job properly, and to support us as we attempt to rest and digest.
Studies show that there aren’t a lot of lions hunting the average American these days. The percentage of Americans, both urban and rural, reporting actually encountering a lion during the course of their day has dropped precipitously since the recent closing of Barnum & Bailey Circus. Meanwhile, our bodies haven’t caught up to the fact that the little stressors of daily life aren’t likely to lead to us being killed and eaten, and these big and little stressors keep your vagus nerve from signaling optimally. Modern life for the average human is full of imaginary lions, stressors that keep our bodies out of optimal balance, and full of inflammatory chemicals.
Let’s Talk Digestion and the Vagus Nerve
When vagus function is out of whack, digestion is out of whack. Symptoms can include heartburn or GERD, IBD or inflammatory bowel disease like ulcerative colitis, and can prevent the body from healing Small Intestine Bacterial Overgrowth (SIBO), a frequent root cause of Irritable Bowel Syndrome (IBS).
The vagus nerve is part of the system that tells the stomach to put out digestive acids and juices, and to start the movement of the gut. When we chew our food, we start the process of mixing the fibers in our food with the digestive acids and enzymes that begin to break food down, before it reaches the stomach, before flowing into the small and then large intestines.
When the vagus nerve isn’t getting or sending the right signals, the flow of food-mixed-with-acid through the gut is slowed. This means that overgrowths of bacteria, yeast or parasites -- as well as used up hormones and toxins that the body worked to eliminate from the body -- are moving through the gut at a slower rate. IBS and SIBO risk are increased with more exposure to bacteria, waste products,potentially worsening any infections present. Exposure to more hormones than your body had planned on can throw hormones out of balance (discussed further below).
Vagus Nerve, MMC and SIBO
In the case of Small Intestine Bacterial Overgrowth (SIBO) the migrating motor complex (MMC) in the gut is not behaving optimally.
I like to think of the MMC as the caboose of a little train moving through our intestines. You eat, and the chewed up food, combined with digestive acids and enzymes, is loaded onto a car on the train, to be moved through your body and out as stool. Every time you eat, the train has to stop and go back to the top of the tracks to pick up the new food.
Several things can stop the train. Reduced vagus nerve firing is a major contributor to MMC dysregulation. Snacking is another one for sure. The train should move all the way through from Central Station, the place right after your stomach (the duodenum) through to its final stop downtown, the anus.
This should be a one-way trip, and the train should leave the station and get to the end of the road every 90-120 minutes. Every time you snack, the train has to stop and go back to pick up this new food-passenger, slowing the movement of food through your digestive track, which can lead to bacterial overgrowth and increased toxin burden in the body.
The MMC can also get derailed or confused by trauma, stress, and other life factors, to be discussed in depth in further articles.
Low Stomach Acid
Folks with IBS, heartburn, reflux and other digestive issues often have low stomach acid, and this too can be a vagus nerve issue. The vagus nerve prompts the cells in the stomach to release histamine, which helps the body to release the stomach acid you need to break down your food.
Low B12 Levels Can Make You Feel Terrible
Many people with chronic digestive concerns also have low B12 levels, which is often due, in part, to not having enough vagus stimulation of the parietal cells in the gut, which leads to low intrinsic factor. Intrinsic factor is the chemical that processes B12 in the stomach, and the cells that release it can be hurt or even killed by eating foods we’re sensitive or allergic to or by having untreated heartburn, gut infections or inflammation.
The function of these cells can be slowed by inappropriate vagus nerve stimulation – if the gut isn’t getting the “All Systems Go” signal from the brain, why would your stomach use all that energy to make B12?
Low B12 levels are linked to fatigue, depression, anxiety, memory problems and dementia, nerve problems such as numbness or tingling, weakness in muscles, GI symptoms such as constipation, gas, diarrhea or lack of appetite.
Let’s Talk Hormones and Lions
I want to go back to talking about Lions here – both real and imagined.
When the vagus nerve is over or under-active, the brain’s hypothalamus isn’t signaling the brain’s pituitary gland appropriately, and the downstream signal to the adrenal glands gets confused. This system is known as the HPA Axis, and when this communication is effected, several hormones can get over- or under-produced (CRH, ACTH and cortisol). This can be part of the set of symptoms commonly referred to as “Adrenal Fatigue.” While that name is not exactly scientifically correct, it’s a useful shorthand for chronic exhaustion or hyper-stimulation leading to anxiety, insomnia and just generally feeling revved up.
That is to say: your body can get triggered into thinking either that All The Lions Are Chasing You Always, or that there is not a single lion out there in the world, nothing to run from, nothing to do, why bother being awake and present to the lion-free world… This can lead to a combination of fatigue, lack of motivation, anxiety, insomnia and generally, a case of the blahs. Vagus nerve stimulation plays a role in helping the body understand when a situation is a True Lion, and when it’s just your boss being your boss, or a looming deadline that feels like doom.
Let’s Talk Circadian Rhythm
A very modern problem that I see daily in my patients is an alteration in circadian rhythm, or our body’s natural sleep/wake signaling. Part of this problem is that most of us have limited activity during the day - we take the subway or car to work, sit for 8-10 hours, car or subway home. We don’t see the sun during our work day, and then sit in front of blue lights at night, such as our phones, television, tablets and computers, which actually tell our brains that its daytime. The blue light that is part of every screen we use mimics the sun, which tells our bodies that it’s time to be awake (and that the lions are awake too), and that our pineal glands in our brains shouldn’t put out melatonin.
I know how tempting it is to check social media before bed, and I know I’m not gaining any fans by urging you to read a paper book before bed… but there are few things your body wants more.
The vagus nerve transmits signals from the circadian control center in the brain, and the effect of circadian dysregulation goes in both directions. Interrupting circadian flow affects the brain, and changes in normal melatonin and other hormone levels before bed can lead to problems with the vagus nerve, which then affects the rest of your body. Furthermore, the circadian control center in the brain sends signals to your digestive system and lungs to produce mucin, the substance that keeps your vital organs healthy and well-lubricated, but only if it’s getting the right signals to do so.
How can regaining appropriate Vagus Nerve Stimulation help you?
It’s simple: when you get your vagus nerve back in proper working order, all the systems listed are free to work optimally. The overall function of your heart, lungs, digestion, reproductive and hormone systems can all be improved by optimizing vagus nerve function.
How to start reengaging the vagus nerve: it’s simple, easy and fun!
Pick one or two things to start adding to your daily routine – start simple, and see if stimulating the vagus nerve can become part of your health care habits!
1. Sing. Loudly! Not a quiet hum, but a full on, top of your lungs good ole sing along. I recommend the shower for this one.
- The muscles in the back of your throat activate the vagus nerve as they move, so sing as loud as possible. Don’t worry about the neighbors. (2)
- Oxytocin, the calming hormone released at birth is also released when we sing. (3)
2. Gargle. You can use regular filtered water for this. I’m a lover of efficiency, so I do this in the shower too. I have a water filter on my shower (I like Berkey brand https://tinyurl.com/y84yabrq) so I can trust that the water I’m gargling is clean and the chlorine has been removed (which my hair and skin and lungs thank me for, too). Once that conditioner is in my hair and doing it’s magic, I gargle like a full-on Muppet. Not a discreet, elegant gargle – the gargle of a small-and-friendly monster.
- You want to gargle hard enough that your eyes start to water
- The added benefit of this is that it makes me laugh, and laughter is amazing medicine! (4, 5, 6) In this case, laughter stimulates the vagus nerve too. Laughter increases beta-endorphins and nitric oxide and benefits the vascular system. (7, 8)
- It’s a win win win. And my hair looks Amazing.
3. Build in some daily prayer and meditation, especially chanting. Try an ommm or two. It may feel silly or weird at first, but it’s good for your health and wellness, as what vibrates the throat stimulates the vagus nerve. It frankly doesn’t matter what you chant, just get to it.
- I love to think about all the things that humans have done since time immemorial because they were just the things that we did. Most religions have some sort of chanting, singing, meditation – from the Rosary to Buddhist chanting to Pagan spiral song to the rhythmic prayer of Judaism. Atheist or just not down with religion? That’s cool. Try chanting whatever noise feels good for you.
- I try to channel my toddler nephews – they’ll take any opportunity to make ridiculous noises and to chant what sounds like nonsense any chance they can – they have an inherent kiddo wisdom that helps their little bodies as they grow and learn. Close the bathroom door, gargle, sing the praises of the Universe or just make loud silly noises. It’s surprisingly freeing…
4. Expose yourself to cold water or air. The vagus nerve is stimulated when the body is exposed to cold. The sympathetic fight/flight system is downregulated (works less) and the parasympathetic rest/digest system is upregulated, or asked to work more to calm you.
- I splash my face with cold water every morning, and at the end of a shower I turn the water as cold as it will go for as long as I can stand it. I started with 2 seconds, and am working up to 2 minutes. (9) Or you can start slowly by putting your face in ice cold water for a few seconds.
- In the winter, I like to open a window in the morning to both greet the day and to get a blast of cold air for just a few seconds.
5. Do yoga. Both the parasympathetic nervous system and the vagus nerve are stimulated by yoga practice, particularly the Sun Salutation. (10,11)
- A study that compared a group of people who walked daily to those doing yoga daily found a significant reduction in anxiety and perceived stress in the yoga group, as well as increases in the mood-improving, anti-anxiety brain chemical GABA. (12)
6. Meditate. Meditation and deep breathing stimulate the vagus nerve. (13, 14, 15)
- Whatever meditation works best for you is the best kind to do – some folks like a guided meditation, some like to focus on the breath, taking 5-10 deep, slow belly breaths. It doesn’t matter what you choose, as long as you make a daily habit of doing at least 2 minutes of meditation every day.
7. Breathe Deeply and Slowly. There are neurons in both the heart and the neck that contain baroreceptors, or cells that monitor your blood pressure, and send signals back and forth with your brain.
- When we take deep, slow belly breaths, we activate the vagus nerve to lower fight or flight, and activate our rest and digest parasympathetic nervous system, thus lowering heartrate, blood pressure and feeling of anxiety. (16)
- On average, we take 10 to 14 breaths per minute – but to stimulate the vagus nerve, try to take only 6 breaths per minute. Breathe in deeply, allowing your stomach to expand, then breathe out very slowly. (17)
8. Serotonin and 5HTP. The neurotransmitter chemical Serotonin activates the vagus nerve through a variety of different receptors in the brain, gut and throughout the body. When there is inflammation in the gut, the amount of serotonin made in the brain is reduced via the quinolate pathway.
- The best way to support optimal brain-body chemistry is start by understanding what is going on in your gut. We can use advanced functional medicine stool and breath tests to evaluate the gut microbiome to see what may be causing inflammation for you. This is something I do for all my patients, especially those with digestive issues, depression, anxiety, skin concerns, hormone imbalances or sleep issues.
- Taking the serotonin precursor 5HTP can help with systemic serotonin support. This supplement can interact with some medications, so be sure to talk with your licensed healthcare provider before starting 5HTP!
9. Add in Prebiotic and Probiotic foods and supplements. The term “gut microbiome” refers to the millions of bacteria in our digestive track, which play a role in nutrient absorption, mood, hormone and neurotransmitter balance to name a few vital functions. The health of our microbiome is a huge determinant of our overall health.
- The vagus nerve is the great connector between the brain and the enteric nervous system, which controls digestion and the gut. Our microbiome plays an important role in making this signaling work.
- Specifically, the probiotic bacterial strain Lactobacillus rhamnosus was shown in animal studies to support optimal levels of the receptors of the calming chemical GABA, which is mediated by the vagus nerve. (18)
- For more on fermented foods, check out these recipes (sauerkraut, beet kvass) for affordable probiotics you can make at home.
- Prebiotics, food for the colon cells, are found in fibrous vegetables. Aim for 6 or more servings of a variety of vegetables each day to optimize the health of your gut, microbiome, colon and vagus nerve.
10. Exercise. When we move, the digestive system is stimulated, and the parastaltic wave which moves stool through the colon is also activated.
- This movement is controlled in part by the vagus nerve, which is also stimulated by exercise, from walking to yoga to crossfit.
- Whatever exercise or movement works for you is the right thing to start with. Try to get some gentle movement daily! (19)
11. Acupuncture. Humans have been stimulating the vagus nerve with acupuncture for ages, and there are several commonly used points which stimulate improved vagus function. (20) Studies show that auricular or ear acupuncture is particularly stimulating for the vagus nerve. (21) (22)
12. Eat fish! Studies show that comsuming omega 3 fatty acids (like those found in fatty fish like salmon) increases vagal tone and activity and puts us into that calming parasympathetic mode more often. (23) I recommend eating small fish, as they have fewer heavy metals in them.
13. Get a massage. Massaging different parts of the body, especially the feet or along the carotid sinus (on the ride side of your neck), which you can do on your own for free, can also stimulate the vagus nerve. Massage is often used to get newborn babies to gain weight because it stimulates their vagus nerves, thereby increasing their gut function. (24)
14. Try Intermittent Fasting. Research shows that fasting may increase vagal tone as well. Fasting may sound intimidating but it is easily accomplished by simply eating dinner around 6-7pm and then not eating again until breakfast at 7 or 8am – that’s a 13-14 hour fast right there! Or you can compress your eating into an 8-10 hour window, say 9am-7pm, for an even longer fast. (25)
There are many different ways to stimulate your vagus nerve. choose 2-3 things that work for you, and make them daily habits by tying them to things you do anyway. If you brush your teeth daily, gargle before or after. If you heat water for coffee or tea daily, hum or sing to yourself while you do it. Make new habits simple, and you'll integrate them with ease.
The beneficial effects of increased vagal nerve function are so far-reaching that it is more than worthwhile for all of us to add some of these new habits into our daily lives.
Imagine feeling more calm and centered - stimulating your vagus nerve is a great place to start. Choose one or two of these options and start today!