Latest / Hardiness with Dr Paul Taylor / Unlocking the Secrets of the Vagus Nerve with Dr Kevin Tracey

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Unlocking the Secrets of the Vagus Nerve with Dr Kevin Tracey · Hardiness with Dr Paul Taylor

• 0:10
  Speaker 1: I'm Tracy. Welcome to the podcast.
• 0:13
  Speaker 2: Thanks for having me on. Paul, it's great to be here.
• 0:16
  Speaker 3: I don't know whether I should call you doctor, professor, researcher,
• 0:22
  Speaker 3: ventor author.
• 0:24
  Speaker 1: I mean, can you make your mind up here? Kevin?
• 0:27
  Speaker 2: Kevin's fine, Kevin's perfect.
• 0:29
  Speaker 3: So you have a Bachelor of Science in chemistry, which
• 0:34
  Speaker 3: I remember is feeling miserably.
• 0:38
  Speaker 1: You also are trained in eurosurgery.
• 0:41
  Speaker 3: You've got seventy five typing patents, that's bonkers, and about
• 0:47
  Speaker 3: four hundred published papers.
• 0:50
  Speaker 1: When are you going to get your finger out and
• 0:51
  Speaker 1: do some work.
• 0:54
  Speaker 2: I'm a lucky guy, Paul. I really love what I do,
• 0:58
  Speaker 2: and I have been able to do medicine and science
• 1:05
  Speaker 2: in the hopes of helping people. And if you're going
• 1:08
  Speaker 2: to translate science into things that actually do help people,
• 1:11
  Speaker 2: that requires turning the science into an invention. And if
• 1:16
  Speaker 2: you're going to have that invention help people, that requires
• 1:19
  Speaker 2: navigating the path from the idea to the invention to
• 1:23
  Speaker 2: actually some sort of clinical product or clinical device or
• 1:27
  Speaker 2: clinical drug. And so I've over the years, I've been
• 1:31
  Speaker 2: doing this for forty years, and in that time I've
• 1:33
  Speaker 2: learned how to navigate the individual steps and I happen
• 1:36
  Speaker 2: to enjoy all of it. So I'm a lucky guy.
• 1:39
  Speaker 2: I'm a very lucky guy. You know. I choose what
• 1:43
  Speaker 2: I get to work on, what I want to work on,
• 1:45
  Speaker 2: and I've gotten to work with brilliant colleagues. But we're
• 1:48
  Speaker 2: doing this for patients, and the patients they don't choose
• 1:51
  Speaker 2: to have the condition they're confronting. They're the heroes and
• 1:55
  Speaker 2: the story, not the people who get to enjoy what
• 1:58
  Speaker 2: they do.
• 1:58
  Speaker 1: Like us.
• 2:00
  Speaker 3: A good point, and the guy, I have your book
• 2:03
  Speaker 3: here and really interesting what happened?
• 2:07
  Speaker 1: I saw your book on Amazon.
• 2:10
  Speaker 3: And I'm like, bye, I want to get that because
• 2:12
  Speaker 3: I'm very interested in the vegus nerve. And then I
• 2:17
  Speaker 3: got an email about you as a potential guest on
• 2:21
  Speaker 3: the podcast, and I hadn't done the connection right and
• 2:25
  Speaker 3: then they said, oh, we'll send your book and send
• 2:27
  Speaker 3: a book, and I'm like, hold on a minute, I'm
• 2:29
  Speaker 3: reading this book right now, and I hadn't done the connection.
• 2:31
  Speaker 3: So it's quite fortuitous, really, But tell us there's a
• 2:36
  Speaker 3: little bit of a story behind why you got into medicine,
• 2:41
  Speaker 3: involving your mom, So can you take the readers through
• 2:44
  Speaker 3: that story? Because I think it's always interesting why people
• 2:47
  Speaker 3: do what they do.
• 2:49
  Speaker 2: When I was five, my mother died suddenly of a
• 2:54
  Speaker 2: brain tumor, a brain tumor called a glioblastoma multiform.
• 3:00
  Speaker 3: End I'm sorry, it's pretty incurable. Shortening was back then
• 3:04
  Speaker 3: was yeah.
• 3:05
  Speaker 2: And unfortunately it was horrible, And unfortunately today for is
• 3:10
  Speaker 2: that we haven't we haven't made a lot of progress
• 3:14
  Speaker 2: in the in the cure of glioblastoma multiform and even today.
• 3:17
  Speaker 2: And that was what some sixty three years ago or something.
• 3:22
  Speaker 2: So at the time she died, her dad, my grandfather,
• 3:26
  Speaker 2: was a professor and pediatrics at Yale Medical School in
• 3:29
  Speaker 2: New Haven, Connecticut, and I remember climbing up on his
• 3:33
  Speaker 2: knee and asking him why didn't the neurosurgeon take the
• 3:36
  Speaker 2: tumor out and then she could come home, And he
• 3:40
  Speaker 2: said that there was no way that could be done
• 3:44
  Speaker 2: because the tumor was like a horseshoe crab and it
• 3:48
  Speaker 2: had tentacles or legs that went through the brain, and
• 3:51
  Speaker 2: if he had pulled on one part of the crab
• 3:53
  Speaker 2: or the tumor, the damage would have extended into my
• 3:57
  Speaker 2: mother's brain into other parts and she wouldn't been the
• 4:00
  Speaker 2: same person. Who she was and and so I said, well,
• 4:04
  Speaker 2: somebody should do something about that, and he said, well,
• 4:06
  Speaker 2: maybe you will. And so your question is a leading one,
• 4:10
  Speaker 2: of course. And now it's you know, three years later,
• 4:14
  Speaker 2: and I'm a neurosurgeon working on trying to invent cures.
• 4:18
  Speaker 2: As you know, Paul, when you're late in a career,
• 4:24
  Speaker 2: you can look back and connect the dots and make
• 4:26
  Speaker 2: a history into a story in it. And it looks
• 4:29
  Speaker 2: like it was a planned trajectory. Was there a plan
• 4:32
  Speaker 2: when I was five? No? Is it interesting that I
• 4:34
  Speaker 2: became a brain surgeon and then a brain surgeon doing
• 4:38
  Speaker 2: research to try to make cures after my grandfather said that, Yes,
• 4:42
  Speaker 2: it's it's it's memorable, it's unforgettable, but it's you know,
• 4:47
  Speaker 2: it's young people listening. Chase your dreams. That's that's the
• 4:51
  Speaker 2: that's the idea. Chase chase your dreams and and do
• 4:54
  Speaker 2: and and and dream that you can help help people
• 4:57
  Speaker 2: or help the world, because that's what we all need. Paul.
• 5:01
  Speaker 1: Yeah, yeah, look absolutely.
• 5:02
  Speaker 3: And so my my daughter's nineteen, my son's fifty, My
• 5:07
  Speaker 3: daughters at university, and she's studying bio medicine, right, and
• 5:11
  Speaker 3: she's at a minute. She's in her second year and
• 5:14
  Speaker 3: she's got one eye on medicine, one eye on a
• 5:17
  Speaker 3: PhD and being a researcher and is And the only
• 5:21
  Speaker 3: advice I've given her is follow whatever you're really curious about,
• 5:26
  Speaker 3: and you know what, what is it that really interests you,
• 5:31
  Speaker 3: because you're probably going to do this for many, many years,
• 5:35
  Speaker 3: and if you're not curious, then it's going to end
• 5:39
  Speaker 3: up being a millstone around your neck your career.
• 5:42
  Speaker 1: So be curious.
• 5:45
  Speaker 3: I take it by your nods and smiles that he
• 5:49
  Speaker 3: would also endorse that advice.
• 5:51
  Speaker 2: I would. And hopefully you're not paying all the tuition bills, Paul,
• 5:55
  Speaker 2: because what I what I what I would add, and
• 5:59
  Speaker 2: you might not like me for this if if you are,
• 6:01
  Speaker 2: But what I would add is that do both. No,
• 6:05
  Speaker 2: nothing's nothing's permanent till you're nothings. Nothing's permanent until you're thirty.
• 6:11
  Speaker 2: And and I don't think anyone should be in a
• 6:14
  Speaker 2: rush to finish their training. And if you need to
• 6:17
  Speaker 2: take more time to be trained in two things instead
• 6:19
  Speaker 2: of one, so be it. If that's you know, you
• 6:22
  Speaker 2: don't do it willy nilly, and you don't do it
• 6:24
  Speaker 2: to delay going into the to the workforce as a strategy.
• 6:28
  Speaker 2: But if you're curious about these things and you love
• 6:31
  Speaker 2: doing both, then do both until you have to only
• 6:33
  Speaker 2: do one. And and I will tell you, Paul, none
• 6:36
  Speaker 2: of her professors are going to tell her what I
• 6:38
  Speaker 2: just said. It's not gonna it's not gonna happen. Everybody says, Oh,
• 6:41
  Speaker 2: you can't do both, Oh you have to focus all this,
• 6:44
  Speaker 2: that and the other thing. No, you can do both,
• 6:46
  Speaker 2: and you should do both until you can, until until
• 6:49
  Speaker 2: the world dictates otherwise. Because it's when you're trained in
• 6:53
  Speaker 2: multiple areas as I have been over the years and
• 6:57
  Speaker 2: am that allows you to create bridges between fields that
• 7:01
  Speaker 2: don't exist. And that's where that's where pioneering advances come from,
• 7:06
  Speaker 2: not just in medicine and science, but pioneering advances in
• 7:09
  Speaker 2: the world come when people bridge fields and make connections
• 7:13
  Speaker 2: that didn't exist. And you know, we're living in an
• 7:15
  Speaker 2: era now where the coin of the realm is usefulness.
• 7:19
  Speaker 2: And if you can bridge fields, whether it's science and
• 7:23
  Speaker 2: medicine or something in something else, you're going to add
• 7:27
  Speaker 2: a value that other people can't because you've been trained
• 7:29
  Speaker 2: in two areas. So I would tell her to train.
• 7:31
  Speaker 3: In both, I fully endorse that, and I fully endorse
• 7:37
  Speaker 3: the you know train for a long time. I've just
• 7:39
  Speaker 3: finished my PhD in psychology at the age of fifty four.
• 7:43
  Speaker 3: But for me, as a long time exercise scientist, nutritionist,
• 7:48
  Speaker 3: it is the bridging the fields. And I call myself
• 7:50
  Speaker 3: a psychophysiologist, and I buying my head off the wall
• 7:55
  Speaker 3: at all these psychologists who think you can optimize for
• 7:58
  Speaker 3: mental health just with thinking skills and that the body's.
• 8:00
  Speaker 1: Got nothing to do with it. It drives me bunkers.
• 8:03
  Speaker 2: But anyway, well, you and Plato poll are on the
• 8:07
  Speaker 2: same page, right, didn't he say, to heal the brain,
• 8:10
  Speaker 2: you heal the body, and to heal the body, you
• 8:12
  Speaker 2: heal the brain. He said soul. But it's the same thing.
• 8:15
  Speaker 1: Yeah, you know, exactly when the Greek's talked about. So
• 8:18
  Speaker 1: they were really talking about that. So let's get back
• 8:21
  Speaker 1: to you.
• 8:22
  Speaker 3: With all of the stuff that you have been interested
• 8:26
  Speaker 3: in over the years, all the stuff that you've done,
• 8:29
  Speaker 3: why did you choose to write a book on one
• 8:33
  Speaker 3: nerve in the body?
• 8:37
  Speaker 2: My life's work culminated in the recently last August. First,
• 8:42
  Speaker 2: I believe with the FDA approval in the United States,
• 8:48
  Speaker 2: of using something that I had originally thought of and
• 8:52
  Speaker 2: improved and invented, using a vagus nerve stimulator to treat
• 8:59
  Speaker 2: rheumatoid arthritis, which is of course as an inflammatory condition. Now,
• 9:05
  Speaker 2: my life's work was bringing this connection to the fore,
• 9:09
  Speaker 2: this connection between the nervous system, the brain, and the
• 9:12
  Speaker 2: immune system. The immune system produces inflammation, and what we
• 9:16
  Speaker 2: discovered is that the brain can control that inflammation or
• 9:20
  Speaker 2: slow it down by sending signals through the vegus nerve.
• 9:25
  Speaker 2: And we can talk about what is the vegus nerve
• 9:27
  Speaker 2: and how it works. But it's a very great nerve,
• 9:31
  Speaker 2: which is the name of the book, and it's great
• 9:34
  Speaker 2: for many reasons, but let's start with a very simple one.
• 9:37
  Speaker 2: It's the only nerve in your body. If you cut
• 9:39
  Speaker 2: it on both sides that it's lethal. Oh wow, I
• 9:44
  Speaker 2: did not know that true. So if it travels from
• 9:48
  Speaker 2: about the it starts in your brain, and it travels
• 9:50
  Speaker 2: from about the level of your ears, down your neck
• 9:54
  Speaker 2: and chest into your abdomen, and along the way it
• 9:56
  Speaker 2: touches all the organs in your body that you don't
• 9:59
  Speaker 2: think about all day long, your heart, your lungs, your liver,
• 10:02
  Speaker 2: your pancras explain, and and we say vegas nerve. But
• 10:07
  Speaker 2: you have two of them, like two thumbs. You have
• 10:09
  Speaker 2: one on each side, and within each of these two
• 10:13
  Speaker 2: vegas nerves. And this is where it gets complicated and interesting.
• 10:18
  Speaker 2: You have one hundred thousand individual fibers, so people, so
• 10:23
  Speaker 2: you have two hundred thousand vegus nerve fibers, and and
• 10:27
  Speaker 2: each and every one of those fibers has has the origin,
• 10:31
  Speaker 2: a beginning, and an end. It begins in either the
• 10:35
  Speaker 2: body or the brain. Those are the ones that go
• 10:37
  Speaker 2: up their sensory where it begins in the brain and
• 10:40
  Speaker 2: goes down to the body. And those aremotor or epharantor
• 10:45
  Speaker 2: or outward traveling from the brain. That means because because
• 10:49
  Speaker 2: they've evolved over hundreds of millions of years, that means
• 10:54
  Speaker 2: that each and every individual fiber of the two hundred
• 10:57
  Speaker 2: thousand fibers has a specific function. Some go to the heart,
• 11:02
  Speaker 2: some go to the spleen, some go to the lungs,
• 11:05
  Speaker 2: and on and on and on down the list. So
• 11:07
  Speaker 2: people talk, you know, almost online anyways, you'll find billions,
• 11:12
  Speaker 2: not millions, billions of web impressions about the vegas nerve.
• 11:17
  Speaker 2: And people wave their arms, and they talk about it
• 11:19
  Speaker 2: like it's a solid copper wire. And someone says, oh,
• 11:22
  Speaker 2: I'm going to do this that or the other thing
• 11:24
  Speaker 2: and stimulate my vegas nerve. And I say, you have
• 11:26
  Speaker 2: two hundred thousand vegas nerves. They each have their own function.
• 11:30
  Speaker 2: Which one are you going to stimulate? And how?
• 11:36
  Speaker 1: And so did today? Are you saying ken that they
• 11:40
  Speaker 1: all act independently?
• 11:42
  Speaker 2: All those yeas?
• 11:43
  Speaker 3: Yes, So they are they all individual neurons essentially all.
• 11:47
  Speaker 1: Well let me ask, let me anatomically, yeah, well, I
• 11:51
  Speaker 1: mean let me.
• 11:52
  Speaker 2: Can you walk and chew gum? Can you chew gum
• 11:54
  Speaker 2: and play the piano? Of course you can, and so
• 11:57
  Speaker 2: can your listeners. And so that's how the nerve system works.
• 12:01
  Speaker 2: So it begins with some sort of a simple animal
• 12:05
  Speaker 2: and evolutionary history, right, a snail or a slug or
• 12:08
  Speaker 2: a jellyfish or something, and it has a few nerves,
• 12:12
  Speaker 2: a lot less than we have, and they and they
• 12:14
  Speaker 2: have reflex functions. So there is a predator on this side,
• 12:20
  Speaker 2: and there's an image of the predator comes in and
• 12:24
  Speaker 2: a nerve reacts to that and it instantly, not instantly,
• 12:29
  Speaker 2: but very quickly activates motor nerves that push the whatever,
• 12:34
  Speaker 2: the snail or the sorry, the slug or the worm
• 12:38
  Speaker 2: or the jelly, push it away from the predator or
• 12:40
  Speaker 2: towards food. These are all hardwired reflexes, and over time,
• 12:45
  Speaker 2: hundreds of millions of years that the nervous system of
• 12:49
  Speaker 2: these evolving animals collects more and more reflexes, until you
• 12:53
  Speaker 2: end up with a brain and a nervous system the
• 12:55
  Speaker 2: size of ours. And that's how evolution works. And each
• 13:02
  Speaker 2: individual nerve still has a simple function. Right, So you're
• 13:06
  Speaker 2: in your doctor's office and she thumps your knee with
• 13:09
  Speaker 2: a rubber hammer and your your leg pops up, and
• 13:12
  Speaker 2: you said, who you know who did that? Right? Well,
• 13:16
  Speaker 2: that was her hammer stretching the pateller tendon and your
• 13:20
  Speaker 2: knee sending a sensory signal up a few nerve fibers,
• 13:23
  Speaker 2: not millions, a few, a few hundred maybe into your
• 13:27
  Speaker 2: spinal cord, and that sends some signals up to your brain,
• 13:29
  Speaker 2: and some of the signals return from the spinal cord
• 13:33
  Speaker 2: to your quadriceps. From Morris, your muscle contracts and your
• 13:36
  Speaker 2: leg goes up. That's a reflex. Well, all your organs
• 13:40
  Speaker 2: are also operating under the reflex control systems. So in
• 13:44
  Speaker 2: the case of the heart, will do the heart first,
• 13:47
  Speaker 2: and then the immune system. The heart. Your heart's beating along,
• 13:51
  Speaker 2: your brain's keeping scores, keeping keeping the pace, and you
• 13:57
  Speaker 2: get startled and your heart rate skips or you think
• 14:01
  Speaker 2: of a stressful thought and your heart rate skips up.
• 14:04
  Speaker 2: That skipping up of your heart activates sensory nerves which
• 14:09
  Speaker 2: tell your heart the heart's beating a lot faster now,
• 14:12
  Speaker 2: which activates a reflex response in your vegus nerve to
• 14:16
  Speaker 2: slow the heart down.
• 14:18
  Speaker 1: Yeah.
• 14:18
  Speaker 2: Well, we discovered. Our basic discovery was that the same
• 14:21
  Speaker 2: thing happens in inflammation. When inflammation raises up to a
• 14:26
  Speaker 2: point that's too high or higher, that is detected by
• 14:32
  Speaker 2: the vagus nerve and other nerves in the nervous system,
• 14:36
  Speaker 2: and the signals from the brain to the immune system
• 14:40
  Speaker 2: in the spleen traveled down the breath the vegus nerve
• 14:44
  Speaker 2: and it works like the breaks on your car. That's
• 14:47
  Speaker 2: the basic discovery.
• 14:50
  Speaker 1: That's pretty cold stuff. I want to return to the
• 14:55
  Speaker 1: immune because I want to spend a little bit of
• 14:56
  Speaker 1: time on the heart.
• 14:57
  Speaker 3: Just because you mentioned the heart first. Heart red variability
• 15:02
  Speaker 3: as a measure of veagal tone talk us through. Is
• 15:11
  Speaker 3: that a perfect measure of legal tone? Are there any limitations?
• 15:17
  Speaker 3: How do you think it is useful? So so I'll
• 15:21
  Speaker 3: give you I kind of am my idea on this
• 15:27
  Speaker 3: with with with my limited knowledge compared to yours, is
• 15:29
  Speaker 3: that and the your HRV can be the canary and
• 15:33
  Speaker 3: the coal mine about how you're dealing with stress in
• 15:37
  Speaker 3: your life and cumulative stress. So kind of commentary on
• 15:41
  Speaker 3: all of that give give us the overview of it.
• 15:45
  Speaker 2: So you asked some very simple questions in the beginning,
• 15:48
  Speaker 2: and then you end it on a very complex point.
• 15:50
  Speaker 2: So I think the simple answers to the simple questions are, No,
• 15:54
  Speaker 2: it's not a perfect measure of vegel tone. Yes, it
• 15:57
  Speaker 2: is widely used. And there's the rub. And I do
• 16:02
  Speaker 2: spend some time on this in the book, And so
• 16:04
  Speaker 2: you're readers who are interested in this discussion may find
• 16:09
  Speaker 2: the book clarifying. But let's break it down because it's
• 16:16
  Speaker 2: actually really important to talk in simple terms on complicated things.
• 16:20
  Speaker 2: So what is heart reveriability? Heart reveriability is a mathematically
• 16:25
  Speaker 2: derived calculation using very complicated math and statistics things like
• 16:30
  Speaker 2: fast foury transformations and things like that, to look at
• 16:34
  Speaker 2: a very simple measure. The simple measure is that is
• 16:38
  Speaker 2: the time in milliseconds, usually between individual heartbeats. So how
• 16:43
  Speaker 2: does that work? Well, I already said that some fibers,
• 16:47
  Speaker 2: not two hundred thousand, but some of the fibers in
• 16:50
  Speaker 2: the vegus nerve going to the heart, maybe a few dozen,
• 16:53
  Speaker 2: maybe a few hundred. When they are activated, the electrical
• 16:58
  Speaker 2: signals traveling down those fibers are converted to chemical signals
• 17:02
  Speaker 2: in the heart and the result is a complex series
• 17:04
  Speaker 2: of steps that causes the heart to beat slower. What
• 17:10
  Speaker 2: does that mean. It means that the vagus nerve is
• 17:13
  Speaker 2: prolonging the time to the next heartbeat. That's how your
• 17:18
  Speaker 2: pulse slows. So what does that mean? Well, what these
• 17:24
  Speaker 2: statistical or mathematical transformations do is they simply count the
• 17:30
  Speaker 2: distance in time, the amount of time between each and
• 17:33
  Speaker 2: every heartbeat for some period of time five minutes, twenty
• 17:36
  Speaker 2: minutes overnight, and that is the number that's applied to
• 17:41
  Speaker 2: which the statistical analysis is applied, whether it's a summation
• 17:46
  Speaker 2: of standard deviations, whether it's distributions around the frequency of
• 17:52
  Speaker 2: the events, and by consensus and by physiological experiments, mostly
• 17:59
  Speaker 2: in analysts animals, but some in human there's a consensus
• 18:02
  Speaker 2: that the that the power of under the curve in
• 18:06
  Speaker 2: the high frequency domain most closely reflects vegas nerve activity.
• 18:12
  Speaker 2: And people say that because if you block the vegas
• 18:15
  Speaker 2: nerve and experiments with drugs or surgery, that that the
• 18:19
  Speaker 2: area and that high frequency part dissipates, So it's controlled
• 18:24
  Speaker 2: by the vegas nerve. So does that mean that that's
• 18:27
  Speaker 2: all there is to it? No, Actually, unfortunately it's only
• 18:30
  Speaker 2: the beginning. And and here we can go through some caveats. First,
• 18:34
  Speaker 2: I said, the math is complicated and the statistics are complicated.
• 18:37
  Speaker 2: They're algorithms that people subject the data to and like
• 18:41
  Speaker 2: other algorithms in the social media universe, you don't know
• 18:44
  Speaker 2: what they are.
• 18:45
  Speaker 3: So and just on that, Kevin, sorry to interrupt that.
• 18:49
  Speaker 3: The different devices, so you're app a watch your garment,
• 18:53
  Speaker 3: they will use different ways of measuring it.
• 18:56
  Speaker 1: You talked about r M, S SD and and and
• 18:59
  Speaker 1: there's there's a whole mindful listener, are we looking at
• 19:02
  Speaker 1: high frequency par low frequency par like once you start
• 19:05
  Speaker 1: to look onto the hood, my god, it gets complicated.
• 19:09
  Speaker 2: Absolutely right, Paul, you took the words out of my mouth.
• 19:12
  Speaker 2: That is the point you cannot say I'm wearing this
• 19:15
  Speaker 2: device today and that device tomorrow and my heart rate variability,
• 19:19
  Speaker 2: no and so, and when you do the experiments yourself.
• 19:23
  Speaker 2: And I've done some of this with my colleague in
• 19:26
  Speaker 2: the lab, saying Gita Schavan. She and I run the
• 19:28
  Speaker 2: lab together here at the fine Stein Institute in New York.
• 19:32
  Speaker 2: Years ago, we built a heart rate variability software package
• 19:36
  Speaker 2: and hardware package on a laptop with some wearables. It
• 19:40
  Speaker 2: made a wearables meaning electrodes like EKG electrodes, because we
• 19:45
  Speaker 2: were doing it here in a clinical research center, and
• 19:47
  Speaker 2: what we found just totally confused me. So we found,
• 19:51
  Speaker 2: for instance, if a patient had periventricular contractions or extra
• 19:55
  Speaker 2: extra ventricular contractions, extra heartbeats or skip to heart beat,
• 20:00
  Speaker 2: you'd have to subtract that from the analysis because it's
• 20:04
  Speaker 2: not the same as everything else. And when you do that,
• 20:07
  Speaker 2: you get a completely different number for the heart rate variability,
• 20:11
  Speaker 2: even if you have thousands and thousands of data points.
• 20:14
  Speaker 2: So I didn't understand that, I said, Statisticians tell me, oh,
• 20:17
  Speaker 2: that's what you'd expect, But I don't understand that. The
• 20:20
  Speaker 2: second thing we observed is everything else also made a difference.
• 20:24
  Speaker 2: Were they sitting down or lying down when we made
• 20:27
  Speaker 2: the recordings. Had they had a cup of coffee or
• 20:29
  Speaker 2: a full breakfast two hours before or had they not
• 20:32
  Speaker 2: eaten at all? Did they Were they breathing that this
• 20:37
  Speaker 2: is really important. Were they breathing on a controlled respiratory
• 20:44
  Speaker 2: cycle or were they breathing randomly, sometimes breathing at eight breaths,
• 20:48
  Speaker 2: sometimes twelve, sometimes sixteen. Huge differences in, you know, and
• 20:54
  Speaker 2: a huge difference in whether you were making the recordings
• 20:57
  Speaker 2: for five minutes or twenty minutes or two or three hours.
• 21:00
  Speaker 2: So when you talk to you're a physiologist, so I
• 21:01
  Speaker 2: don't have to tell you all this, But when you
• 21:03
  Speaker 2: talk to physiologists about this, if you don't control for
• 21:06
  Speaker 2: all these variables, you can't compare it. You can't and
• 21:09
  Speaker 2: the age of the patient and everything else. Then you
• 21:11
  Speaker 2: can't make direct comparisons across And that's what you're seeing
• 21:14
  Speaker 2: online now on social media. You're seeing these generic recommendations
• 21:19
  Speaker 2: about HRV, which you know, for a population level measure
• 21:26
  Speaker 2: of thousands or hundreds of thousands of people, and may
• 21:29
  Speaker 2: have some truthfulness, but we all know you can't apply
• 21:32
  Speaker 2: a population statistic to an individual person or case anymore
• 21:37
  Speaker 2: than you can say somebody's going to win the lottery
• 21:39
  Speaker 2: and the odds of the winning or losing or x,
• 21:42
  Speaker 2: Y or z, and therefore I'm going to win or lose.
• 21:45
  Speaker 2: You don't know from a population.
• 21:48
  Speaker 3: So but if we then zero in on the individual,
• 21:51
  Speaker 3: my right, what is the utility or the usefulness of
• 21:58
  Speaker 3: having one device bocking it over time on one device,
• 22:03
  Speaker 3: And do you think that's useful for the individual? There's
• 22:06
  Speaker 3: a reflection of kind of high their bodies dealing globally
• 22:10
  Speaker 3: with stress.
• 22:12
  Speaker 2: Maybe. So again it's complicated. So let's let's talk about
• 22:19
  Speaker 2: the other thing we that one hundred percent influences is
• 22:22
  Speaker 2: that we haven't talked about yet. So we've said that
• 22:25
  Speaker 2: there's one part of the of the high free of
• 22:28
  Speaker 2: the analysis that gives you the high frequency curve, if
• 22:32
  Speaker 2: you will, or the high frequency domain which reflects vegas nerve.
• 22:36
  Speaker 2: But there's a couple of other ones that that give
• 22:39
  Speaker 2: that that that point to either the input from the
• 22:43
  Speaker 2: fight or flight, the sympathetic nervous system to the heart,
• 22:46
  Speaker 2: which tends to speed it up. And in the context
• 22:50
  Speaker 2: anyways of this specific thing we're talking about, you have
• 22:55
  Speaker 2: you have inputs that speed up the heart and inputs
• 22:57
  Speaker 2: that slow down the heart. Sympathetic comparison, I'm not saying
• 23:01
  Speaker 2: they act in opposition. I'm just saying they both have
• 23:04
  Speaker 2: inputs that pushing in different directions, and so people call
• 23:10
  Speaker 2: that sympathovagel balance and things like that. Well, I'm not
• 23:14
  Speaker 2: really sure. I'm not really sure how to break that
• 23:19
  Speaker 2: down into a recommendation for an individual person for the
• 23:24
  Speaker 2: for the very simple reason that we don't have enough
• 23:27
  Speaker 2: well controlled, randomized clinical trial data using as you said,
• 23:33
  Speaker 2: one device in a particular cohortic patience for a particular condition.
• 23:38
  Speaker 2: So you could have a you could have people with
• 23:41
  Speaker 2: with with very healthy if you will, heart rate variability
• 23:46
  Speaker 2: numbers with some condition or problem in their brain or
• 23:53
  Speaker 2: in their body that is not affecting heart rate, or.
• 23:58
  Speaker 1: Whether there's other conditions that very strongly affected.
• 24:03
  Speaker 2: Right well, and the one that comes top of mind
• 24:05
  Speaker 2: because we I think it's the best studied at this
• 24:07
  Speaker 2: point is COVID. So at the end of the COVID pandemic,
• 24:11
  Speaker 2: there was some very important work out of Spain. Autopsy
• 24:15
  Speaker 2: studies showed that a lot of people, a significant percentage
• 24:18
  Speaker 2: of people who in this relatively small study, but I
• 24:21
  Speaker 2: think it was eight out of twelve or something like
• 24:23
  Speaker 2: that had damage to their vegas nerve. And they looked
• 24:28
  Speaker 2: in the vegas nerve and they found that there was
• 24:32
  Speaker 2: virus there, the COVID for the SARS virus, and they
• 24:36
  Speaker 2: found inflammation and nerve damage. So now the question gets
• 24:39
  Speaker 2: turned around, right did the heart is the heartbreat variability
• 24:43
  Speaker 2: a problem of stress or caused by some sort of
• 24:47
  Speaker 2: stress imbalance, or is it a problem that their vegas
• 24:49
  Speaker 2: nerve was actually damaged and couldn't carry the signals? And
• 24:54
  Speaker 2: you need both. You need vegas nerve input and you
• 24:57
  Speaker 2: need fight or flight or sympathetic input. And you're the physiologist,
• 25:02
  Speaker 2: you probably know. The study of the of the sheep
• 25:04
  Speaker 2: in New Zealand on the treadmill studied by the exis.
• 25:09
  Speaker 1: Oh you don't, I don't know this study.
• 25:11
  Speaker 2: No, tell me, well, it sounds like a far sight cartoon, right,
• 25:14
  Speaker 2: You've got a bunch of sheep in the lab running
• 25:16
  Speaker 2: on a treadmill. So it was a study in New Zealand.
• 25:24
  Speaker 2: It published an extremely reputable journals just a few years ago.
• 25:29
  Speaker 2: And here's what they found. They found when the sheep
• 25:32
  Speaker 2: started running up a twenty percent incline that their cardiac
• 25:35
  Speaker 2: output increase and their heart rate increase, and that was
• 25:39
  Speaker 2: in association with an increase in their fight or flight response,
• 25:42
  Speaker 2: exactly what you teach everybody in extra hise physiology. And
• 25:46
  Speaker 2: therefore that means that it must have turned off the
• 25:51
  Speaker 2: parasympathetic rest and digest because they act in opposition right, wrong. Wrong.
• 25:56
  Speaker 2: What they found is when they blocked well, first of all,
• 25:59
  Speaker 2: they measured the vegus nerve in those sheep and it
• 26:02
  Speaker 2: was also turned on. And when they blocked it, cardiac output,
• 26:06
  Speaker 2: coronary blood flow, and I believe VO two max all declined.
• 26:12
  Speaker 2: In other words, the collaboration, the dance between vegas input
• 26:18
  Speaker 2: and fight or flight input is the key. Now, every
• 26:22
  Speaker 2: physiologist knows that everything in organ system functioning is that
• 26:27
  Speaker 2: when you turn something on, you turn on the off
• 26:30
  Speaker 2: switch at the same time. You know, you turn on insulin,
• 26:34
  Speaker 2: you turn on glucagon, you turn on blood clotting, you
• 26:37
  Speaker 2: turn on fiber analysis, and you can go right down
• 26:41
  Speaker 2: the list. And that's exactly what's happening with the vaguel
• 26:44
  Speaker 2: input to the heart. Is that when you turn on sympathetic,
• 26:48
  Speaker 2: you also turn on parasympathetic. So to optimize function. So
• 26:54
  Speaker 2: how much of that is being captured in heart revariability?
• 26:57
  Speaker 2: I would say it depends. Can you take a heart
• 27:00
  Speaker 2: rate variability number and draw all kinds of specific conclusions
• 27:04
  Speaker 2: for a specific patient? I would say probably not. Can
• 27:07
  Speaker 2: we as you as you framed it before? Can we
• 27:12
  Speaker 2: can we using consistent measures in a patient about which
• 27:15
  Speaker 2: we know a lot of other things? You know, maybe
• 27:18
  Speaker 2: we know they're physically fit, Maybe we know they have
• 27:20
  Speaker 2: a low heart rate at rest, which is another that's
• 27:22
  Speaker 2: a very good sign of vegas nerve tone or a
• 27:25
  Speaker 2: low resting heart rate, and we know their.
• 27:28
  Speaker 3: Hearts a lot of Sorry, that's what a lot of
• 27:30
  Speaker 3: athletes use to use as a measure of their training status,
• 27:34
  Speaker 3: that when they were going into overtraining, their resting heart
• 27:39
  Speaker 3: rate would change by a few bits either one way or.
• 27:42
  Speaker 1: The other, and that was a kind of an early
• 27:44
  Speaker 1: warning sign.
• 27:45
  Speaker 2: Right absolutely. I think in a highly trained athlete under
• 27:48
  Speaker 2: under regular physiological monitoring, where you know where you're starting
• 27:52
  Speaker 2: with your restern heart rate, you know where you're starting
• 27:54
  Speaker 2: with your diet, you know what drugs they're on, you
• 27:56
  Speaker 2: know what their baseline, as you said before, their baseline.
• 27:59
  Speaker 2: HIV is using a consistent machine with data collected at
• 28:04
  Speaker 2: the same respiratory rate in the same body position. Yes,
• 28:07
  Speaker 2: I think, I think. I think that's great. I see
• 28:10
  Speaker 2: a problem and and uh, you know, I've done a
• 28:12
  Speaker 2: few podcasts lately talking about the book, and a number
• 28:16
  Speaker 2: of doctors and clinicians have said that they they see
• 28:20
  Speaker 2: in their patients, you know, these these wide variable swings
• 28:24
  Speaker 2: in the patient's heart rate variability and could it be
• 28:27
  Speaker 2: stressed And I'm like, well, it could be, but it
• 28:29
  Speaker 2: could also be changing the measurement, change in the breathing,
• 28:32
  Speaker 2: change in the time of day, so.
• 28:34
  Speaker 3: And whether whether or not they had a skin full
• 28:36
  Speaker 3: of alcohol, how their sleep was right, because I find
• 28:40
  Speaker 3: looking at mine, I tell you, when I drink alcohol, boom,
• 28:43
  Speaker 3: my HRV dropped significantly.
• 28:46
  Speaker 1: If I've been exercise, So I think it's quite useful
• 28:48
  Speaker 1: on that global level. If you know your own behaviors right.
• 28:53
  Speaker 2: Your own behaviors and your own baseline, you'll love this boss.
• 28:56
  Speaker 2: So there's a there's a there's a really important physiology
• 29:00
  Speaker 2: reason for heart revariability, and that is too.
• 29:04
  Speaker 1: Uh.
• 29:04
  Speaker 2: It's the it's the nervous system's way, the brain's way,
• 29:07
  Speaker 2: if you will. In the autonomic nervous system's way of
• 29:11
  Speaker 2: optimizing blood flowing to and through the heart with air
• 29:16
  Speaker 2: flowing to and through the lungs. And I talk about
• 29:19
  Speaker 2: this at length with a sort of self experimentation from
• 29:23
  Speaker 2: my dear friend and colleague in Stockholm hulf Anderson, who
• 29:28
  Speaker 2: who actually published his own data from showing the synchronization
• 29:37
  Speaker 2: of the heart rate variability tracings with the respiratory tracings
• 29:44
  Speaker 2: when breathing at a at a fixed pace as guided. Yes, yes,
• 29:50
  Speaker 2: and so you can you can you can say maybe
• 29:53
  Speaker 2: the whole thing about heart reveriability is nowhere near as important.
• 29:57
  Speaker 2: You may have very good heart revariability, but if it's
• 30:00
  Speaker 2: not synchronized with your respiratory variability, then you're not You're
• 30:04
  Speaker 2: not in a good physiological state. And that to me
• 30:08
  Speaker 2: is really interesting and and with with some with some
• 30:12
  Speaker 2: very rare exceptions, almost nobody's measuring that there's a device
• 30:18
  Speaker 2: out there that does that. I think it started in
• 30:20
  Speaker 2: heart heart hearts, heart mass that maybe maybe I don't
• 30:25
  Speaker 2: know what happened to the technology from Finland that was
• 30:29
  Speaker 2: showing the the overlap between the respiratory rate variability and
• 30:36
  Speaker 2: heart rate variability, you know, as a function of respiratory
• 30:39
  Speaker 2: sinus arrhythmia. But when those when those peaks coincide, that
• 30:44
  Speaker 2: that was a sign of complete health, and any amount
• 30:48
  Speaker 2: of alcohol the night before disrupts that synchrony even more,
• 30:53
  Speaker 2: even more than it disrupts heart rate variability.
• 30:56
  Speaker 3: Right, That's interesting, And look, we might come back to
• 30:59
  Speaker 3: that around briefing, but I do want to come back
• 31:01
  Speaker 3: to inflammation and the inflammatory reflex and the road of
• 31:08
  Speaker 3: the big star. So bring us down this pathway and
• 31:12
  Speaker 3: just twe then vegus nerve is playing a role or
• 31:19
  Speaker 3: reflective or whatever it may be in terms of inflammatory conditions,
• 31:22
  Speaker 3: and then we can get into the modulation stuff, which
• 31:25
  Speaker 3: is pretty exciting.
• 31:26
  Speaker 1: Shit, it's it's.
• 31:28
  Speaker 2: Been it's been an amazing it's been an amazing ride.
• 31:31
  Speaker 2: I mean, we've been working on this for twenty five years.
• 31:34
  Speaker 2: We can talk about it till till tomorrow morning if
• 31:36
  Speaker 2: you want that. We know as much about how this works,
• 31:41
  Speaker 2: how the vegus nerve turns off inflammation. We know as much,
• 31:44
  Speaker 2: probably more actually than we know about how most anti
• 31:47
  Speaker 2: inflammatory drugs actually work. I can Yeah, we can go
• 31:51
  Speaker 2: in the brain of a mouse and we can activate
• 31:53
  Speaker 2: a few pulsations, spikes, neural spikes using a method called
• 31:59
  Speaker 2: opto genetics, where you make individual neurons sensitive to a
• 32:03
  Speaker 2: laser light and we can shine the laser light on
• 32:06
  Speaker 2: those specific neurons at the origin of the brain of
• 32:10
  Speaker 2: the vegus nerve in the brain of a mouse, and
• 32:12
  Speaker 2: we can follow the electrical activity down the vegus nerve
• 32:16
  Speaker 2: through the neck of the mouse down into the abdomen.
• 32:18
  Speaker 2: We can show where the signals are converted from electrical
• 32:22
  Speaker 2: signals to chemical signals at a structure in the abdomen
• 32:25
  Speaker 2: of the mouse called the ganglia, which is a home
• 32:29
  Speaker 2: for nerves. So the vegus nerve ends there and it
• 32:33
  Speaker 2: activates another nerve down the chain. That nerve we can
• 32:36
  Speaker 2: show gets electrically activated and carry signals into the spleen.
• 32:41
  Speaker 2: We can show that inside the spleen the electrical signals
• 32:44
  Speaker 2: converted to another chemical one. This chemical now, the first
• 32:47
  Speaker 2: chemical was acetylcholine. The second chemicals norpinephrin. The nouropaephyrin activates
• 32:54
  Speaker 2: T cells, not all of them, but some and the
• 32:58
  Speaker 2: ones that express coaling as Setel transphrase, which means they
• 33:01
  Speaker 2: make a setyl coline. They now get turned on. And
• 33:04
  Speaker 2: so what you end up with is remarkable. From a
• 33:07
  Speaker 2: few flashes of a laser light in the brain of
• 33:11
  Speaker 2: a mouse, you get acetyl coline and no open ephron
• 33:15
  Speaker 2: cranking through the spleen to the point. And this goes
• 33:18
  Speaker 2: for hours, even from a few From a few, yes,
• 33:22
  Speaker 2: it goes for hours and hours because once these cells
• 33:25
  Speaker 2: downstream get turned on, they crank and they make lots
• 33:28
  Speaker 2: of neurotransmitters. Even though the electrical signal stops, they keep
• 33:33
  Speaker 2: pushing out the acetyl coline in the neuroper ephrin that
• 33:36
  Speaker 2: comes you get. There's so much of these neurotransmitters being
• 33:39
  Speaker 2: made in the spleen of a mouse you can actually
• 33:42
  Speaker 2: measure them coming out the splenetic vein. And it's those
• 33:45
  Speaker 2: neurotransmitters that slow down the inflammation in your body's white
• 33:49
  Speaker 2: blood cells as they pass through the spleen. And nobody
• 33:53
  Speaker 2: saw it as coming not when we started back in
• 33:55
  Speaker 2: the nineteen nineties, and even when we had worked out
• 33:58
  Speaker 2: all the science I just explained people still kind of were.
• 34:03
  Speaker 2: Scientists said Okay, well this is scientifically interesting, but doctors
• 34:06
  Speaker 2: were like this, how can this can't work in people?
• 34:09
  Speaker 2: Can it?
• 34:12
  Speaker 1: And now it was just so little diversion, Kevin, and
• 34:15
  Speaker 1: we will come back.
• 34:16
  Speaker 3: To this, But is this why in the study of
• 34:22
  Speaker 3: and I think it was in Penas in twenty fourteen
• 34:24
  Speaker 3: of the guys doing the vim Hoff breathing and then
• 34:28
  Speaker 3: and injected with an endotoxin, how they suppressed information?
• 34:34
  Speaker 1: Is that then was the no.
• 34:35
  Speaker 3: Epenephyrine basically driving that inflammatory response.
• 34:42
  Speaker 2: I'm impressed, Paul. We have openings in my lab if
• 34:45
  Speaker 2: you're looking for work in these states. That's that's a
• 34:51
  Speaker 2: really important point. So the simple answer is yes, that's
• 34:55
  Speaker 2: the answer. And the complicated answer is, and we could
• 34:59
  Speaker 2: talk about this a few different ways, but when fight
• 35:03
  Speaker 2: or flight happens, you have a measurable increase in epinephrine
• 35:09
  Speaker 2: and ripe and effron and depending on how long, also
• 35:12
  Speaker 2: glogle cortiicoids. And you can measure these things in the blood.
• 35:16
  Speaker 2: It's some of them, some of them are harder to
• 35:18
  Speaker 2: measure than others because they have short half lives. But
• 35:20
  Speaker 2: you can also measure the the metabolites of these things
• 35:23
  Speaker 2: in the urine. And so this has been studied for
• 35:27
  Speaker 2: a long time. I mean, I remember when I was
• 35:30
  Speaker 2: a post doc working at the New York Hospital and
• 35:34
  Speaker 2: Corno Medical Center and Rockefell University in New York City.
• 35:37
  Speaker 2: We used to we used to bring yeah occurs because
• 36:12
  Speaker 2: your white blood cells release. Back then we would we
• 36:17
  Speaker 2: were measuring individual cytokines like TNF and ile one. Today
• 36:21
  Speaker 2: we call that cytokine storm, and that's what it was
• 36:23
  Speaker 2: called all during COVID. But back then when we were
• 36:26
  Speaker 2: doing this, cytokines were new things. We were measuring them
• 36:28
  Speaker 2: one at a time. But that's what it was. What
• 36:30
  Speaker 2: we found is if we infused epinephrin or norepinephyrin into
• 36:36
  Speaker 2: the blood of these volunteers, they didn't get sick. So
• 36:40
  Speaker 2: so a chemical fight or flight, which is what that
• 36:44
  Speaker 2: really is, would prevent cytokine storm. And so that's what
• 36:49
  Speaker 2: wim Hoff is doing when when he and he and
• 36:54
  Speaker 2: this was proved. So I studied Whim down the hall
• 36:57
  Speaker 2: from here in your.
• 36:59
  Speaker 1: Birth actually had vim in and he was before, way before.
• 37:03
  Speaker 3: It was before that study was actually carried out in
• 37:06
  Speaker 3: two thousand and four.
• 37:06
  Speaker 2: So we did that study on Whim as an equals Won.
• 37:11
  Speaker 2: I think it was two thousand and seven before anyone,
• 37:16
  Speaker 2: you know, before he was famous as the iceman, and
• 37:19
  Speaker 2: we put him in saying gede, and I drew his
• 37:22
  Speaker 2: blood and put him in an exam room and shut
• 37:24
  Speaker 2: the door and we went and got coffee or something.
• 37:27
  Speaker 2: Came back two hours later and we drew his blood again,
• 37:30
  Speaker 2: and uh we said, okay, mister hop that's it. You know,
• 37:34
  Speaker 2: come back in a week and we'll see what all
• 37:35
  Speaker 2: these results are. He comes back in a week and
• 37:38
  Speaker 2: seeing ed and I looked at him. It's like, whim,
• 37:40
  Speaker 2: what did you do when we left? He goes. I
• 37:44
  Speaker 2: breathed like a motherfucker. Whose story? So he said why
• 37:53
  Speaker 2: and we said, because you turned off your side of
• 37:55
  Speaker 2: kind storm? And he said, are you going to publish me?
• 37:59
  Speaker 2: I said no, we're not going to publish. Why can't
• 38:01
  Speaker 2: you publish me? I said, because you're an equals one.
• 38:03
  Speaker 2: We don't have any controls. You know, what do we
• 38:06
  Speaker 2: have to do to publish me? Well, you should get
• 38:09
  Speaker 2: you know, ten or twelve people and ten or twelve
• 38:11
  Speaker 2: controls and do it again. And if that works, have
• 38:15
  Speaker 2: the trained people teach the controls to cross over and
• 38:19
  Speaker 2: do that. And that's the paper you read in the PNAS.
• 38:21
  Speaker 2: That was like five or eight years later, and on
• 38:25
  Speaker 2: a bunch of media events, Whim has acknowledged that what
• 38:30
  Speaker 2: I just told you is true, and thank me. But
• 38:32
  Speaker 2: I'm going to be on stage with him and Colonel
• 38:35
  Speaker 2: Jeff Lange at south By Southwest in March in Austin, Texas,
• 38:39
  Speaker 2: if anybody's in Texas. Yeah, yeah, that's.
• 38:43
  Speaker 3: Nice closing of the look. But so this brings it
• 38:47
  Speaker 3: to the point, and we will come back to the inflammation.
• 38:49
  Speaker 3: But that they and and it was really fascinating also
• 38:53
  Speaker 3: in your book that acute activation of the sympathetic nervous
• 38:59
  Speaker 3: system has different effects than chronic activation of the sympathetic
• 39:04
  Speaker 3: nervous system.
• 39:05
  Speaker 2: Right, absolutely, So I.
• 39:08
  Speaker 3: Think Kevin has huge implications overall health.
• 39:13
  Speaker 2: One hundred percent agree with you, Paul. It probably has
• 39:15
  Speaker 2: huge implications for heart revariability. It's just more difficult to
• 39:18
  Speaker 2: understand in the book. As you know, I split these
• 39:22
  Speaker 2: things into pieces, right, you know, whim hot breathing I
• 39:25
  Speaker 2: separated from cold exposure. Fighter flight I separated from rest
• 39:28
  Speaker 2: and digest acute from chronic because all these things have
• 39:32
  Speaker 2: different effects, you know. And so in the chronic fighter flight,
• 39:38
  Speaker 2: there's overwhelming evidence chronic low grade fighter flight as opposed
• 39:42
  Speaker 2: to this sort of massive voluntary acute fighter flight. The
• 39:48
  Speaker 2: holding your breath until you feel like you're gonna die,
• 39:51
  Speaker 2: and then take that big breath that you know that
• 39:53
  Speaker 2: induces a massive fighter flight. Turning the water in the
• 39:57
  Speaker 2: shower on a full cold or jumping in a cold bath,
• 40:02
  Speaker 2: that's fight or flight. It's instant. It's And tell your
• 40:06
  Speaker 2: listeners not to combine the breathing with the ice bath
• 40:09
  Speaker 2: unless I.
• 40:10
  Speaker 1: Always do that.
• 40:11
  Speaker 3: And I actually know somebody was in a session that
• 40:15
  Speaker 3: I was doing and I was telling them that, and
• 40:17
  Speaker 3: she came up to me after she was really interested
• 40:19
  Speaker 3: in her her boyfriend had actually died. Yeah, no, you
• 40:22
  Speaker 3: can't trying to do that, that that vim Hoff breathol
• 40:26
  Speaker 3: training and then trying to go onto what because you
• 40:28
  Speaker 3: can pass.
• 40:28
  Speaker 2: Out right, yeah, hyperventilate, Yeah, you hyperventilate, you lose the
• 40:33
  Speaker 2: urge to breathe. Then the cold water is to some
• 40:35
  Speaker 2: people faint. If you faint, don't have a urge to breathe,
• 40:37
  Speaker 2: it's a disaster.
• 40:39
  Speaker 1: I mean I do so, Kevin, sorry, can I go back?
• 40:41
  Speaker 3: So the with the vim Hoff style breathing with the
• 40:44
  Speaker 3: controlled hyperventilation and then the breath hold, So the breath
• 40:49
  Speaker 3: hold it gives an extra stimulus to the sympathetic nervous system.
• 40:54
  Speaker 2: Yeah, the hyperventilation, you're just blowing off CEO two. You
• 40:57
  Speaker 2: get the tingling in your lips and and and that's
• 41:00
  Speaker 2: that's that's very well known. And and it's the it's
• 41:04
  Speaker 2: the hold. It's the breath holding that induces the fight
• 41:08
  Speaker 2: or flight.
• 41:09
  Speaker 3: That's interesting, okay, because I thought the hyperventilation in and
• 41:13
  Speaker 3: of itself would activate the fighter flight.
• 41:17
  Speaker 2: It might, it might to a degree, But the hyperventilation,
• 41:20
  Speaker 2: what it's really doing is letting you hold your breath longer.
• 41:23
  Speaker 3: And so if you're going off seal to you and
• 41:24
  Speaker 3: it's not low oxygen and actually when people do it,
• 41:27
  Speaker 3: if you haven't done any vim.
• 41:28
  Speaker 1: Half stuff, and you know, you get to a third
• 41:31
  Speaker 1: and fourth round and and you know.
• 41:34
  Speaker 3: The breath hold is you can actually expel earlier out
• 41:37
  Speaker 3: of your lungs and not breathe, and you can get
• 41:40
  Speaker 3: up to it like two.
• 41:41
  Speaker 1: I've done over two minutes. I've seen somebody at four minutes.
• 41:44
  Speaker 2: I've done. I've done I've done three forty five. And
• 41:46
  Speaker 2: I'm not wow and I'm not a rage, but I
• 41:49
  Speaker 2: do it lying down on the floor of my gym.
• 41:52
  Speaker 1: Yeah yeah, yeah, yeah, yeah yeah.
• 41:55
  Speaker 3: And I think there are some Actually this is another
• 41:58
  Speaker 3: diversion we probably don't need to go down, but that
• 42:00
  Speaker 3: acute hypoxia in the Brian and the harmetic effect and
• 42:04
  Speaker 3: some of the benefits as well as well as hypercoptie
• 42:07
  Speaker 3: as well. There's so much interesting shit around the breath
• 42:10
  Speaker 3: and how it can can actually modulate our physiology.
• 42:15
  Speaker 2: Right one hundred percent. I mean Andrew Huberman's podcast he
• 42:18
  Speaker 2: talked about this quite a bit. He talks about when
• 42:21
  Speaker 2: you take two breaths in like like like sniffs and
• 42:28
  Speaker 2: holds the physiological side and then maybe that takes two
• 42:32
  Speaker 2: or three seconds, and then hold it for a little
• 42:35
  Speaker 2: bit and then five or six or seven count on
• 42:40
  Speaker 2: an exhale through first lips. You know, now you're breathing
• 42:44
  Speaker 2: at a respiratory at six or something like that. And
• 42:47
  Speaker 2: when he walks through how that works, the first thing
• 42:49
  Speaker 2: he points out is that when you do that physiological side,
• 42:53
  Speaker 2: you're expanding your lung volume and that's active activating pressure
• 42:57
  Speaker 2: sensors in your lungs, which sends signals up your vegus nerve.
• 43:01
  Speaker 2: So right away you quote stimulated your vegus nerve. But
• 43:07
  Speaker 2: it's a few fibers in your lung that go up
• 43:10
  Speaker 2: to your brain. That's totally different than electrically stimulating, if
• 43:15
  Speaker 2: you will, the fibers that go down from your brain
• 43:18
  Speaker 2: to your heart or your immune system. Now, when you
• 43:22
  Speaker 2: stimulate those incoming fibers with the physiological sniffs, they activate
• 43:27
  Speaker 2: the locus ceruleus and the nucleus tractus solitarius. The locus
• 43:31
  Speaker 2: ceruleus is the origin of the fight or flight response.
• 43:34
  Speaker 2: So you have this signal coming in through your vegas nerve,
• 43:38
  Speaker 2: which is activating signals going out your sympathetic nerves. So
• 43:45
  Speaker 2: it's complicated. And and you know Charles Sherrington who has
• 43:50
  Speaker 2: won the Nobel Prize for being essentially the father of neuroscience.
• 43:55
  Speaker 2: With modern neuroscience with Ramoni Cahl, Sherrington knew everything. He
• 44:00
  Speaker 2: gave us the roadmap to understand everything about reflexes, and
• 44:05
  Speaker 2: his very famous treatise, The Integrative Action of the Nervous System,
• 44:09
  Speaker 2: he talks about the fact that you have to understand
• 44:12
  Speaker 2: a simple reflex signal in Everything starts with that in
• 44:16
  Speaker 2: simp uh, some sort of connection or inter neuron and
• 44:20
  Speaker 2: a signal out. And then he said, you can assemble
• 44:23
  Speaker 2: reflexes together and you can build a complex nervous system.
• 44:26
  Speaker 2: And then he said, having said all that, there's no
• 44:29
  Speaker 2: such thing as a simple reflex, because all the nerves
• 44:32
  Speaker 2: in your body are connected to all the other nerves
• 44:34
  Speaker 2: in your body one way or another, which is fascinating.
• 44:39
  Speaker 2: It's fascinating. So look, I understand why people say, do this,
• 44:43
  Speaker 2: that and the other thing. Stimulate your vegus nerve live along,
• 44:46
  Speaker 2: healthy life, and and and and and it's fine for
• 44:50
  Speaker 2: those people who who are you know, are under medical
• 44:54
  Speaker 2: supervision and enjoy self experimentation and and can afford to
• 44:58
  Speaker 2: try different devices. And that's all find and good. Where
• 45:01
  Speaker 2: where I where I say let the buyer beware is
• 45:06
  Speaker 2: when people are selling stuff, you know, buy this to
• 45:10
  Speaker 2: do this for your vegas nern Now I'm like, oh,
• 45:12
  Speaker 2: show me the data, where's your where's your clasical trial?
• 45:17
  Speaker 3: Yeah, and I bought one. It just start of interest
• 45:20
  Speaker 3: because of the of the area that I work in.
• 45:23
  Speaker 3: I think it was the greatest load of horseship, that
• 45:25
  Speaker 3: device that goes around your neck.
• 45:26
  Speaker 1: Right. So, but but we we will get into that.
• 45:30
  Speaker 3: I do want to bring the conversation now back to
• 45:33
  Speaker 3: inflammation and that inflammatory reflex, and let's talk about the
• 45:38
  Speaker 3: role and in certain conditions, and how the vegus nerve
• 45:42
  Speaker 3: and manipulation of the vegas nerve can be helpful.
• 45:46
  Speaker 2: We have, as I started to say before, we have
• 45:49
  Speaker 2: we have exquisite knowledge about the fibers that travel from
• 45:54
  Speaker 2: the brain to this plane to turn off side of
• 45:56
  Speaker 2: kind storm and in animal models of arthritis and lamatory
• 46:00
  Speaker 2: Biel disease, multiple sclerosis, diabetes, metabolic syndrome, obesity, stroke, and
• 46:07
  Speaker 2: I'm probably leaving out a couple all of these conditions,
• 46:11
  Speaker 2: there is data that activating that inflammatory reflex, those vagus
• 46:16
  Speaker 2: nerve fibers that stop inflammation. Activating that reflex gives a
• 46:22
  Speaker 2: significant advantage to the animal, either its survival or its
• 46:26
  Speaker 2: ability to fight off that disease because it slows down
• 46:30
  Speaker 2: the inflammation.
• 46:31
  Speaker 3: We also, now, does this disease have to be have
• 46:35
  Speaker 3: to have an autoimmune component?
• 46:37
  Speaker 2: Now we can note we can do it with animals
• 46:40
  Speaker 2: with sepsis and animals with cytokine storm from endotypesmetry. Yeah,
• 46:45
  Speaker 2: anything that activates what we call the innate immune system,
• 46:49
  Speaker 2: the cytokine produced by white blood cells like monocytes and macrophages.
• 46:54
  Speaker 2: And none of this wouldn't I wouldn't be on your
• 46:57
  Speaker 2: show right now. And I wouldn't have written the book
• 46:59
  Speaker 2: if it if this didn't all apply to human beings.
• 47:02
  Speaker 2: But it does. I mean, we've done clinical trials. The
• 47:05
  Speaker 2: company that did all the clinical trials in this is
• 47:08
  Speaker 2: a company I founded called set Point Medical. I co
• 47:12
  Speaker 2: founded it with my friend and colleague Shah Warren back
• 47:15
  Speaker 2: in two thousand and seven. And set Point Medical is
• 47:18
  Speaker 2: a California company now that has FDA approval because they
• 47:23
  Speaker 2: showed in a clinical trial of patients with severe rheumatoid
• 47:27
  Speaker 2: arthritis that implanting a device the size of a multi
• 47:32
  Speaker 2: vitamin on the left vegas nerve at about the level
• 47:36
  Speaker 2: of the Adams Apple and turning that device on for
• 47:39
  Speaker 2: one minute a day, that that is a therapy that
• 47:44
  Speaker 2: allowed patients with severe rheumatoid arthritis to enjoy significant improvement
• 47:49
  Speaker 2: in their symptoms eighty percent of the patients within one year. Now, Paul,
• 47:53
  Speaker 2: these patients were not getting improvement from all of these
• 47:58
  Speaker 2: powerful immunosuppressive drugs that are out there.
• 48:02
  Speaker 1: And those immune like drugs.
• 48:04
  Speaker 3: I think this is the thing for people to understand
• 48:07
  Speaker 3: drugs are not super targeted the way people think that
• 48:11
  Speaker 3: they are. Right, if you're taking an immuno suppressant to
• 48:14
  Speaker 3: try to manage your arthritis that is going to have
• 48:17
  Speaker 3: widespread knock on effects.
• 48:19
  Speaker 2: They have the most serious side effects that the FDA.
• 48:25
  Speaker 1: Will approve.
• 48:26
  Speaker 2: And because the side effects are so serious, these most
• 48:29
  Speaker 2: of these drugs, if not all of them for RA
• 48:32
  Speaker 2: have a black box warning, which means serious side effects
• 48:36
  Speaker 2: include things like cancer, sepsis, tuberculosis. So that's the thing.
• 48:42
  Speaker 2: There are people who've looked at this trial and said, oh,
• 48:44
  Speaker 2: I wish the effects size was bigger, And I'm like, well,
• 48:47
  Speaker 2: you haven't talked to the patients. Because the patients who
• 48:49
  Speaker 2: are having the effects from this vegas nerve stimulator, their
• 48:52
  Speaker 2: effects size before the vegas nerve stimulator was zero.
• 48:56
  Speaker 1: Yeah, exactly.
• 48:58
  Speaker 2: So that's the future. Oh, this this device goes in
• 49:02
  Speaker 2: through about a one inch incision. It's a same day surgery.
• 49:05
  Speaker 2: You're going in the morning, at home in the afternoon.
• 49:08
  Speaker 2: We know that it's not immunal suppressive. We have forty
• 49:10
  Speaker 2: years experience using other kinds of vegas nerve stimulation for
• 49:15
  Speaker 2: depression and epilepsy. We know that it's not going to
• 49:19
  Speaker 2: be a recurring cost because the battery in the device
• 49:23
  Speaker 2: is recharged with a collar the patient puts on like
• 49:27
  Speaker 2: a collar once a week to charge charges through the skin.
• 49:32
  Speaker 2: We know that on a cost basis that if you
• 49:36
  Speaker 2: look in the United States, the biologics for ra cost
• 49:40
  Speaker 2: upwards of fifty thousand dollars a year. So that means
• 49:43
  Speaker 2: for a fifty thousand dollars surgery that within two years,
• 49:47
  Speaker 2: everybody's saving money, the patients, the insurance companies, the hospitals, everybody.
• 49:52
  Speaker 2: And we know that the drugs that people are using
• 49:54
  Speaker 2: today only work about half the time. And we know
• 49:59
  Speaker 2: that the set Points clinical trial, which needed about two
• 50:05
  Speaker 2: hundred and forty two patients, Guess how many people tried
• 50:08
  Speaker 2: to sign up.
• 50:10
  Speaker 1: I would imagine there's dogs and to sign up.
• 50:13
  Speaker 2: Thirty thousand, wow, thirty thousand people. Thirty thousand people, many
• 50:19
  Speaker 2: of them. If you asked the doctors of those patients,
• 50:22
  Speaker 2: the doctors like, oh, my patients are fine. Well, thirty
• 50:25
  Speaker 2: thousand patients tried to sign up for the clinical trial
• 50:28
  Speaker 2: of two hundred and forty two pass.
• 50:30
  Speaker 3: Now.
• 50:30
  Speaker 2: All of this work was led by the chief medical
• 50:33
  Speaker 2: officer at set Point, David Chernoff, and by a real
• 50:38
  Speaker 2: world class rooumatologist out of Arizona named John Tessa and
• 50:42
  Speaker 2: the papers published its open access for no paywall in
• 50:47
  Speaker 2: a very reputable journal called Nature Medicine, one of the
• 50:50
  Speaker 2: highest impact journals in your world. So that paper's out
• 50:53
  Speaker 2: there for any of your listeners with Ara who want to.
• 50:56
  Speaker 1: Read it, and my book keeper, I'll put it in
• 51:01
  Speaker 1: the show notes. And so then that what in the
• 51:07
  Speaker 1: year view, Kevin. Does that open the door to you?
• 51:11
  Speaker 2: It opens, Yeah, it opens the door to a new
• 51:14
  Speaker 2: world that is already happening. In the United States. We've
• 51:17
  Speaker 2: implanted down the hall from me. We enrolled the first
• 51:22
  Speaker 2: two patients in the United States under the FDA approval,
• 51:25
  Speaker 2: and that was in August or September, and since then,
• 51:28
  Speaker 2: I think we've implanted twelve more. I think they have
• 51:31
  Speaker 2: now the company has now implanted patients in Chicago and
• 51:34
  Speaker 2: a couple of other US centers. And this is just
• 51:36
  Speaker 2: the beginning poll. For a number of reasons, First, it works, Second,
• 51:40
  Speaker 2: patients want it. Third, it's cost effective. Fourth, it's safe.
• 51:45
  Speaker 2: And I think you're going to see because of the
• 51:48
  Speaker 2: way regulations work, it's going to be a year or
• 51:51
  Speaker 2: two in just our a patients who are not responding
• 51:54
  Speaker 2: to available therapies. But I think You're also going to
• 51:57
  Speaker 2: see very soon more clinical try and hopefully FDA approvals
• 52:02
  Speaker 2: for conditions like inflammatory bio disease, Crohn's disease, all sort
• 52:06
  Speaker 2: of colitis, and multiple sclerosis. I think will be the
• 52:09
  Speaker 2: ones that will come soonest, because we've already seen some
• 52:11
  Speaker 2: really interesting data on those.
• 52:13
  Speaker 3: Yeah, that was going to be My question is what
• 52:15
  Speaker 3: cops do you think are going to be off the
• 52:18
  Speaker 3: rank next?
• 52:20
  Speaker 1: And you've just mentioned.
• 52:21
  Speaker 2: Those, well, you know with for inflammatory biol disease, there
• 52:25
  Speaker 2: are published studies. Set Point, and I actually helped them
• 52:29
  Speaker 2: on a number of those studies, has published that in
• 52:33
  Speaker 2: open label pilot studies, which is how you have to start.
• 52:36
  Speaker 2: You can't do everything. You start with twenty people open
• 52:40
  Speaker 2: label and then you go to a large randomized clinical trial,
• 52:42
  Speaker 2: which is what happened for RA. But yes, we've seen
• 52:45
  Speaker 2: the open label trials for IBD work in the lab.
• 52:50
  Speaker 2: We've published that the multiple sclerosis mouse model works beautifully,
• 52:55
  Speaker 2: and so I think set Point will very soon be
• 52:58
  Speaker 2: doing clinical trials on multiple sclerosis patients. I think there
• 53:03
  Speaker 2: are clinical studies going on out there for conditions like
• 53:06
  Speaker 2: obesity and metabolic syndrome and diabetes, and there's always been
• 53:10
  Speaker 2: interest in is this vagus nerve connection between the brain,
• 53:16
  Speaker 2: the immune system and the gut. Is it's somehow involved
• 53:19
  Speaker 2: in conditions like Alzheimer's, in Parkinson's, And.
• 53:22
  Speaker 3: There's a very interesting lines of research Parkinson's first, right,
• 53:29
  Speaker 3: that seems to be originating in the gut. Now some
• 53:31
  Speaker 3: stuff about Alzheimer's as well. And you know that whole
• 53:36
  Speaker 3: gut bringing immune axis is a fascinating word, isn't it.
• 53:40
  Speaker 2: Well, if you want to if you want to get
• 53:42
  Speaker 2: a if you want to get a smile on your face,
• 53:44
  Speaker 2: go back you dig it out of the dig it
• 53:46
  Speaker 2: out of the out of the literature and find doctor
• 53:49
  Speaker 2: Parkinson's description of Parkinson's disease. And he said, he said
• 53:56
  Speaker 2: that the early signs and symptoms are things like constipation
• 53:59
  Speaker 2: involved this far.
• 54:00
  Speaker 1: There you go, There you go, Jesus, I think forgot
• 54:05
  Speaker 1: about for decades.
• 54:06
  Speaker 2: Yep, yep, until and now they're now they proved it
• 54:09
  Speaker 2: in animals. The clinical data are accumulating. You know that
• 54:14
  Speaker 2: for years when I was training to be a surgeon,
• 54:17
  Speaker 2: a routine operation for peptic ulcer disease was to cut
• 54:22
  Speaker 2: the vegas nerves to the stomach because that controls gastric
• 54:27
  Speaker 2: acid release, and so you would cut the vegas nerves
• 54:31
  Speaker 2: and the acid would go down and the patient would
• 54:34
  Speaker 2: feel better. That was before some Australians got the Nobel
• 54:37
  Speaker 2: Prize for proving peptic ulcer disease wasn't caused by acid,
• 54:40
  Speaker 2: it was caused by bacteria. Yeah, So that the reality
• 54:45
  Speaker 2: is that that there are there are thousands of people
• 54:49
  Speaker 2: on the planet Earth that have had their vegas nerves
• 54:53
  Speaker 2: cut below the diaphragm. Now I said it was lethal.
• 54:55
  Speaker 2: It's lethal if you cut it up high in the neck,
• 54:58
  Speaker 2: not down low. And so that gave an opportunity for
• 55:01
  Speaker 2: people recently in the last few years to go back
• 55:04
  Speaker 2: through medical records and ask a very simple question, did
• 55:07
  Speaker 2: your risk of Parkinson's go down if you had your
• 55:10
  Speaker 2: vagus nerves cut for peptic ulcer disease? And the answer
• 55:14
  Speaker 2: is yes.
• 55:15
  Speaker 1: Wow, Really, that's so cool? Does it? And you may
• 55:22
  Speaker 1: not know the answer to that question.
• 55:23
  Speaker 4: If you don't, then speculate, but does cutting it somewhere
• 55:27
  Speaker 4: somewhere dying, whether it's lung's, heart, spleen, whatever, does cutting
• 55:32
  Speaker 4: it there have knock on effects or is it just
• 55:36
  Speaker 4: purely or localized effect.
• 55:38
  Speaker 3: I'm thinking of because because it's two way. Yes, if
• 55:41
  Speaker 3: you cut it, you can you can stop something stimulating.
• 55:44
  Speaker 1: Something you don't want.
• 55:45
  Speaker 3: But is there any drawbacks or knock on effects on
• 55:51
  Speaker 3: intended consequences going back up the team, Well, we.
• 55:56
  Speaker 2: Know in animal experiments, we know that the signals are
• 56:03
  Speaker 2: traveling in both directions from the gut to the brain
• 56:05
  Speaker 2: and from the brain to the gut. And we could
• 56:08
  Speaker 2: talk about I was going to talk about brain development. Well,
• 56:14
  Speaker 2: can I give you two stories that are answers? Okay,
• 56:17
  Speaker 2: the first ones in mice and the second ones in
• 56:19
  Speaker 2: mice and people. So in mice, if you raise a
• 56:23
  Speaker 2: mouse in a germ free environment, so it doesn't have
• 56:26
  Speaker 2: an intestinal microbiome basically, or it may have a few bacteria,
• 56:31
  Speaker 2: but it's not a wild type microbiome full of bacteria
• 56:34
  Speaker 2: like will like would be found in the in the
• 56:37
  Speaker 2: wild germ free environment, like the boy in the bubble.
• 56:39
  Speaker 2: These are mice. If you let those mice live in
• 56:42
  Speaker 2: that germ free environment with no gut microbiome, their brains
• 56:46
  Speaker 2: develop abnormally. Wow, And they they don't have they don't
• 56:52
  Speaker 2: have good coordination, they fall off the rhodo rod, they
• 56:55
  Speaker 2: don't have good learning, and memory. They don't have normal
• 56:59
  Speaker 2: social behavior. It's not a subtle thing. It's a big deal.
• 57:04
  Speaker 2: If you then take those mice before it gets before
• 57:08
  Speaker 2: it gets to be too long. Early on, if you
• 57:11
  Speaker 2: intervene and put the microbiome from a normal mouse into
• 57:16
  Speaker 2: the germ free mouse and wait a week, the brain
• 57:20
  Speaker 2: will start to develop normally again, but not if you
• 57:24
  Speaker 2: cut the vegas nerve.
• 57:27
  Speaker 1: There you go, there you go.
• 57:29
  Speaker 2: So so. Thinking along those kinds of lines, people wondered, well,
• 57:35
  Speaker 2: the golps that we inject to lose weight or control glucose,
• 57:40
  Speaker 2: what happens there? Well, it turns out that when you
• 57:43
  Speaker 2: inject GOLP in a mouse or a person, you have
• 57:48
  Speaker 2: decreased glucose, increased insulin sensitivity, and decreased body weight and
• 57:53
  Speaker 2: decrease food intake. That's why people take it. If you
• 57:56
  Speaker 2: cut the vegas nerve, it doesn't work. Really wow, So
• 58:01
  Speaker 2: the glps are sending signals up the vegas nerve, very
• 58:05
  Speaker 2: carefully done studies in mice. A surgeon in the UK
• 58:09
  Speaker 2: read this in mice that I've been to do that
• 58:10
  Speaker 2: in people. So he had cancer patients who were going
• 58:15
  Speaker 2: to have their stomachs operated on and had to have
• 58:18
  Speaker 2: their vegas nerves cut for part of the stomach surgery
• 58:21
  Speaker 2: for their gastric cancer. So he gave them golps as
• 58:24
  Speaker 2: a controlled experiment, and they had the normal GLP response.
• 58:27
  Speaker 2: I don't feel so hungry, Mike. Glucose went down, My
• 58:30
  Speaker 2: insulin sensitivity got better. Then he did the surgery and
• 58:34
  Speaker 2: repeated the golps. It didn't work.
• 58:37
  Speaker 1: Hit the bad.
• 58:41
  Speaker 2: Wild that is bunkers.
• 58:44
  Speaker 1: So it's mediated through vegas nerve activity.
• 58:47
  Speaker 2: Yeah, and once again, Paul, it's two hundred thousand vegas
• 58:50
  Speaker 2: nerve fibers. One hundred and sixty thousand of them are sensory,
• 58:55
  Speaker 2: forty thousand or motor. So when someone talks about well,
• 58:58
  Speaker 2: I'm humming, so I'm still simulating my vegus nerve. I
• 59:02
  Speaker 2: try to be polite and I'm like, yes, when you hum,
• 59:07
  Speaker 2: you have taken some kind of breath. You have stimulated
• 59:10
  Speaker 2: that part of your vegas nerve with the pressure in
• 59:12
  Speaker 2: your lungs, and when you exhale, that's done other kind
• 59:16
  Speaker 2: of breath. So you've stimulated that part of the vegas nerve.
• 59:19
  Speaker 2: And because you're humming and a branch is some branches
• 59:22
  Speaker 2: of the vegas nerve, go to your vocal cords that
• 59:25
  Speaker 2: control the the you know, your soundbox, your larynx. Yes,
• 59:30
  Speaker 2: you've stimulated that, But does that mean you've stimulated the
• 59:33
  Speaker 2: vegas dear to your pancreas. Does that mean you've stimulated
• 59:36
  Speaker 2: the vegas irve to your spleen? No, I don't know.
• 59:39
  Speaker 2: I mean you can walk into gum, so different different
• 59:43
  Speaker 2: fibers do different things, and your your brain is complicated
• 59:48
  Speaker 2: and somehow it coordinates it all. And I think it's
• 59:51
  Speaker 2: the inability to understand for all of us how sophisticated
• 59:56
  Speaker 2: and complicated this really is that makes it easy for
• 59:58
  Speaker 2: people to wave their hands and online and on social
• 1:00:01
  Speaker 2: media and say, you know, I've I've I've mastered everything
• 1:00:05
  Speaker 2: about my vegas nerve because I I hummed this morning.
• 1:00:14
  Speaker 1: So but author and I I am aware that you
• 1:00:17
  Speaker 1: have to go unfortunately. But are there is there anything
• 1:00:21
  Speaker 1: out there that you see in the internet that you go,
• 1:00:24
  Speaker 1: oh yeah, oh yeah, yeah, that's got some utility.
• 1:00:28
  Speaker 2: Well, I think the things that that have utility are
• 1:00:31
  Speaker 2: the things that I'm sure you use in your practice
• 1:00:33
  Speaker 2: and your your doctor uses on you. You know, we
• 1:00:36
  Speaker 2: should we should pay attention to healthy lifestyles. We should,
• 1:00:40
  Speaker 2: you know, eat a balanced diet, get a good night's sleep.
• 1:00:43
  Speaker 2: Focus on the things in life you can control, not
• 1:00:45
  Speaker 2: the things you can't, you know, maintain some sort of
• 1:00:48
  Speaker 2: a balance and harmony of work in life. Try to
• 1:00:52
  Speaker 2: give back something to the world, to your community, to
• 1:00:55
  Speaker 2: your family, Cherish those loving relationships, have a hobby, read
• 1:00:59
  Speaker 2: a book, work out, and when you work out, you know,
• 1:01:03
  Speaker 2: combine some some some yoga or stretching type workout with
• 1:01:09
  Speaker 2: with VO two max exercises and strength training and these
• 1:01:14
  Speaker 2: and and do I do cold exposure, Yeah, once or
• 1:01:17
  Speaker 2: twice a week. I put the shower on full cold
• 1:01:19
  Speaker 2: and and I get that fight or flight response. And
• 1:01:22
  Speaker 2: do I do some breath work, Yeah, I do. I
• 1:01:25
  Speaker 2: meditate because it makes me feel better. And the data
• 1:01:28
  Speaker 2: are overwhelming that if these interventions are stimulating the vegus
• 1:01:35
  Speaker 2: nerve to the inflammatory system, which they make, they might be.
• 1:01:38
  Speaker 2: And we could talk about that for a minute if
• 1:01:40
  Speaker 2: we have a few more minutes, but that if if
• 1:01:44
  Speaker 2: they are doing that, and you are reducing your inflammatory burden,
• 1:01:48
  Speaker 2: it's a Pascal's wager. It's probably a really good thing
• 1:01:51
  Speaker 2: for you to to decrease the amount of inflammation on
• 1:01:54
  Speaker 2: a day to day basis in your body. And if
• 1:01:56
  Speaker 2: it doesn't work and you don't mind doing it, and
• 1:01:58
  Speaker 2: you can afford to buy these interventions, then I don't
• 1:02:03
  Speaker 2: see a harm in it. I do see a harm
• 1:02:06
  Speaker 2: in practitioners who say, well, if I've got these patient
• 1:02:09
  Speaker 2: and if I could just get her to breathe more,
• 1:02:11
  Speaker 2: her rumatartar aarthritis would go away. No, that's not right.
• 1:02:14
  Speaker 2: You know, if it was that easy, a lot of
• 1:02:17
  Speaker 2: patients with rumatar aarthritis would take care of it. And
• 1:02:19
  Speaker 2: maybe in rumatata arthritis their vagus nerve is actually damaged,
• 1:02:23
  Speaker 2: or maybe in rumatar authritis it's not rumatori aarthritis, it's
• 1:02:26
  Speaker 2: some undiagnosed infection that's affecting their joints that we haven't
• 1:02:30
  Speaker 2: figured out yet. There's just lots of other things you
• 1:02:33
  Speaker 2: can say and do. Before we blame the patient because
• 1:02:37
  Speaker 2: the interventions don't work. It might be that we that
• 1:02:40
  Speaker 2: we just don't have enough information. And so that's where
• 1:02:43
  Speaker 2: that gets my dander up, because you know, we do
• 1:02:46
  Speaker 2: have a lot of science behind a lot of these things,
• 1:02:48
  Speaker 2: and we have people spending doing their life's work to
• 1:02:51
  Speaker 2: try to figure these things out and we are making
• 1:02:54
  Speaker 2: progress and advances, and you can't just wave your hands
• 1:02:58
  Speaker 2: and say that you know, that doesn't mean anything because
• 1:03:04
  Speaker 2: they figured this out in ancient China thousands of years ago,
• 1:03:08
  Speaker 2: you know. So some we need a hybrid approach, right,
• 1:03:11
  Speaker 2: We need a hybrid approach where people take responsibility when
• 1:03:15
  Speaker 2: they can and do the best they can for healthy lifestyles.
• 1:03:18
  Speaker 2: But we also have to acknowledge that doctors and caregivers
• 1:03:21
  Speaker 2: are held accountable for the therapies they're giving. They're held
• 1:03:25
  Speaker 2: accountable to make recommendations based on randomized clinical trials and
• 1:03:29
  Speaker 2: large data sets and their experience and knowledge of what's first,
• 1:03:34
  Speaker 2: do no harm?
• 1:03:36
  Speaker 1: Yeah, yeah, totally agree, the first, no heart. It's got
• 1:03:39
  Speaker 1: to be first. It's got to be the guiding principle. Right.
• 1:03:45
  Speaker 1: My memory is a little bit sketchy on this. I
• 1:03:47
  Speaker 1: need to find a paper and send it to you
• 1:03:49
  Speaker 1: and maybe we have a conversation offline. But I remember
• 1:03:51
  Speaker 1: reading a paper.
• 1:03:53
  Speaker 3: It was in either rots or mice that had a mass,
• 1:03:57
  Speaker 3: and they put them into old water and routinely, and
• 1:04:03
  Speaker 3: I think they had another half that had that didn't
• 1:04:05
  Speaker 3: have the mas, and what they found was regrowing on
• 1:04:09
  Speaker 3: the of the mile and sheath on the ones that
• 1:04:12
  Speaker 3: were exposed to the cold routinely, and they're I'm a
• 1:04:16
  Speaker 3: bit sketchy about the theory, but it was basically that
• 1:04:19
  Speaker 3: then the fire or flight like with that real cold,
• 1:04:24
  Speaker 3: that is going to dominate everything else. So it was
• 1:04:27
  Speaker 3: just basically it's about what was their theory about.
• 1:04:33
  Speaker 1: Energy, and it was energy partitioning, and they were saying
• 1:04:36
  Speaker 1: it was like, when.
• 1:04:37
  Speaker 3: It's cold, it's going to focus everything on that and
• 1:04:40
  Speaker 3: dampen other things down. And now without reading the paper
• 1:04:45
  Speaker 3: and just thinking that that mechanistically, do you think there
• 1:04:51
  Speaker 3: is some sort of potential there?
• 1:04:54
  Speaker 1: And this is without you actually reading the paper, right,
• 1:04:56
  Speaker 1: So I get that.
• 1:04:58
  Speaker 2: Well, it's okay because we talk about there are lots
• 1:05:01
  Speaker 2: of papers actually that suggest that even in humans with
• 1:05:06
  Speaker 2: with with MS, that intermittent cold exposure can help interrupt
• 1:05:11
  Speaker 2: their clinical syndrome. And there are people who there are
• 1:05:14
  Speaker 2: some MS patients who self treat when they lose some
• 1:05:17
  Speaker 2: function of some body part, they get in the in
• 1:05:22
  Speaker 2: cold water and they can restore that function. So this
• 1:05:24
  Speaker 2: is a known thing. What we don't know the mechanism,
• 1:05:27
  Speaker 2: and it is very possible to me that the acute
• 1:05:32
  Speaker 2: exposure cold does activate fight or flight, and that does
• 1:05:35
  Speaker 2: have anti inflammatory mechanisms, so that could contribute. That's a
• 1:05:39
  Speaker 2: testable hypothesis. It's hard to test in people, but you
• 1:05:43
  Speaker 2: can you can study it in people. What's equally interesting
• 1:05:46
  Speaker 2: to me, And here's where I alluded to it a
• 1:05:49
  Speaker 2: minute ago, But when you really try to find high
• 1:05:51
  Speaker 2: quality physiology studies of cold exposure, there's not a lot
• 1:05:55
  Speaker 2: of them. You'd yeah, okay, you've looked. So I did
• 1:06:00
  Speaker 2: kind a couple. I talk about them in the book,
• 1:06:01
  Speaker 2: and the book is fully referenced. You can find things
• 1:06:05
  Speaker 2: like soldiers in in the in the Baltic States, or
• 1:06:08
  Speaker 2: in Sweden or Finland. They douse them in cold water
• 1:06:12
  Speaker 2: and put them in a cold room for hours at
• 1:06:13
  Speaker 2: a time. And the key there is they let them
• 1:06:17
  Speaker 2: get cold adapted. And then they ask questions, does that
• 1:06:21
  Speaker 2: cause increased vegas nerve activity? Yes, because their heart rate
• 1:06:26
  Speaker 2: will slow down once they get cold adapted, And does
• 1:06:29
  Speaker 2: it cause decreased inflammation? And the best studies I found
• 1:06:35
  Speaker 2: said yes. And the best studies I found used methods
• 1:06:40
  Speaker 2: that are very similar to the ones we talked about before,
• 1:06:43
  Speaker 2: from from the wim Hoff study and the Proceedings of
• 1:06:46
  Speaker 2: the National Academy of Sciences by Peter Pickers from from
• 1:06:50
  Speaker 2: from the from Holland, from the Netherlands. These studies they
• 1:06:55
  Speaker 2: ask if I take white blood cells out of the body,
• 1:07:00
  Speaker 2: and I put them in a test tube and I
• 1:07:02
  Speaker 2: activate them with bacterial endotox and how much cytokines do
• 1:07:06
  Speaker 2: they make? So we call that ex vivo out of
• 1:07:08
  Speaker 2: the body stimulation, and it turns out in the cold
• 1:07:11
  Speaker 2: adapted volunteers they make a lot less cytokines in those
• 1:07:16
  Speaker 2: white blood cells that are cold adapted than the ones
• 1:07:18
  Speaker 2: before they were cold adapt So I put that whole
• 1:07:21
  Speaker 2: thing together, and really importantly the vegas nerve stimulation studies
• 1:07:26
  Speaker 2: that we did again published in the Proceedings of the
• 1:07:29
  Speaker 2: National Academy of Sciences with Yakov Lavigne and his team
• 1:07:32
  Speaker 2: at set point, we showed that when we electrically stimulated
• 1:07:36
  Speaker 2: the vegus nerve of the MS animals these this is
• 1:07:40
  Speaker 2: called EAE, we saw decreased inflammation expected that, but we
• 1:07:45
  Speaker 2: also saw increased myelination from the vegas nerve stimulation, which
• 1:07:50
  Speaker 2: is what you said they saw in the cold rats.
• 1:07:53
  Speaker 2: So wouldn't that be great if it works in people?
• 1:07:55
  Speaker 2: We don't know yet. We have to do the clinical trial.
• 1:07:58
  Speaker 1: Yeah, very interesting. She got Portsmouth University.
• 1:08:01
  Speaker 3: I forget his blood me and I can't believe because
• 1:08:03
  Speaker 3: I've had him on the podcast and talked to him
• 1:08:05
  Speaker 3: several times.
• 1:08:06
  Speaker 1: I'm having a brilliant fought.
• 1:08:07
  Speaker 3: But he's done some really interesting cold exposure stuff where
• 1:08:11
  Speaker 3: it's where people lie down on this kind of sort
• 1:08:15
  Speaker 3: of teable on the water and then one leg gets
• 1:08:18
  Speaker 3: submerged in the cold so they can look and do
• 1:08:21
  Speaker 3: biopsies and stuff of one leg.
• 1:08:23
  Speaker 2: Like.
• 1:08:23
  Speaker 1: That's where we start to get into pretty code experiments,
• 1:08:25
  Speaker 1: isn't it.
• 1:08:26
  Speaker 2: Well, it is, but you know it's experiments like that.
• 1:08:29
  Speaker 2: It wasn't It wasn't until fairly recently that that researchers
• 1:08:34
  Speaker 2: actually proved that putting ice on a swollen joint decreases
• 1:08:39
  Speaker 2: the inflammation in the in the knee and ankle. I mean,
• 1:08:42
  Speaker 2: that kind of work is still our current, which is
• 1:08:45
  Speaker 2: a riot. You would think somebody would have studied this
• 1:08:49
  Speaker 2: thousand years ago, but they didn't.
• 1:08:50
  Speaker 1: Yeah, and I'm very interesting now. I do know that
• 1:08:55
  Speaker 1: you do have to go. What are you excited about
• 1:08:57
  Speaker 1: for the future? Just before we let go.
• 1:09:01
  Speaker 2: I'm excited that patients and doctors agree on a basic
• 1:09:05
  Speaker 2: vegas nerve vocabulary, because that will be the fastest route
• 1:09:10
  Speaker 2: to knock down barriers. Look, there's barriers to putting vagus
• 1:09:14
  Speaker 2: nerve stimulators in people with an inflammatory or automune condition.
• 1:09:18
  Speaker 2: A lot of the barriers are based on precedent. People
• 1:09:21
  Speaker 2: aren't used to doctors and patients are used to taking
• 1:09:24
  Speaker 2: pills and injections. They're not used to thinking about medical
• 1:09:28
  Speaker 2: devices with rechargeable batteries to treat an inflammatory disease. We
• 1:09:32
  Speaker 2: have to change, change the workflows. We have to change
• 1:09:35
  Speaker 2: the way people think and talk about this, and my
• 1:09:37
  Speaker 2: book tries to do that. It tries to give a
• 1:09:39
  Speaker 2: common language, tries to give a series of stories that
• 1:09:44
  Speaker 2: bring this whole thing to life. And my hope and
• 1:09:49
  Speaker 2: my hope and dream is that many people start talking
• 1:09:53
  Speaker 2: about this and that it shortens the path for patients
• 1:09:56
  Speaker 2: who need new therapies to at least know that there's
• 1:09:59
  Speaker 2: new options out there. It's not going to work in everybody.
• 1:10:02
  Speaker 2: It's not snake oil. I'm not selling anything. I just
• 1:10:05
  Speaker 2: want the idea to be on the tip of people's
• 1:10:08
  Speaker 2: tongues so that those who can benefit from the therapy
• 1:10:12
  Speaker 2: get benefit, and so that scientists and researchers, my colleagues
• 1:10:16
  Speaker 2: are motivated to do more and go faster because there's
• 1:10:19
  Speaker 2: a lot of people that can benefit from this. Millions
• 1:10:21
  Speaker 2: and millions of people can benefit from this idea eventually.
• 1:10:25
  Speaker 1: Yeah.
• 1:10:25
  Speaker 5: Absolutely, And I think a big take home here for
• 1:10:28
  Speaker 5: people is, before you go spending a shit lead load
• 1:10:31
  Speaker 5: of money on these vegus nerve stimulators on the internet,
• 1:10:35
  Speaker 5: make sure you're exercising well, make sure you're sleeping well,
• 1:10:38
  Speaker 5: making sure you're doing a bit of breath work, particularly
• 1:10:41
  Speaker 5: controlling your stress, do some bit of cold exposure, eat well.
• 1:10:45
  Speaker 3: Do all those things first before you go spanding your
• 1:10:48
  Speaker 3: money on all this expensive shit. And if you're doing
• 1:10:51
  Speaker 3: all of that, then yes, go and spend some money
• 1:10:54
  Speaker 3: and run a little experiment.
• 1:10:58
  Speaker 1: Awesome, Kevin. That was a big thumbs up for people
• 1:11:01
  Speaker 1: who are not watching and just listening. Kevin, listen, this
• 1:11:06
  Speaker 1: is awesome.
• 1:11:06
  Speaker 3: And thank you on behalf of mankind for you taking
• 1:11:12
  Speaker 3: the time, which I know is pressive because I imagine
• 1:11:15
  Speaker 3: where you are there's so much shit you can do
• 1:11:17
  Speaker 3: with your time. But thank you for writing a book
• 1:11:21
  Speaker 3: which I think is the best one that I have
• 1:11:23
  Speaker 3: read yet in this area, although I haven't completely.
• 1:11:26
  Speaker 1: Finished it, but so for the listeners. The great Nerve
• 1:11:31
  Speaker 1: by Kevin J. Tracy MD and thank you for your work.
• 1:11:35
  Speaker 2: Kevin, thank you and thanks for having me on. Paul.
• 1:11:37
  Speaker 2: It's great to know you.
• 1:11:39
  Speaker 1: Yeah, it's bloody awesome. Thanks mate,