What Most Has My Attention Right Now — Credible (vs. Bogus) Vagus Nerve Stimulation (#824)

Kevin J. Tracey, MD (@KevinJTraceyMD), is president and CEO of the Feinstein Institutes for Medical Research at Northwell Health, a pioneer of vagus-nerve research, and author of the recent book The Great Nerve: The New Science of the Vagus Nerve and How to Harness Its Healing Reflexes. 

His contributions include identifying the therapeutic action of monoclonal anti-TNF antibodies and discovering the specific reflex control of immunity by the nervous system, called the “inflammatory reflex.” These discoveries launched the new scientific field called bioelectronic medicine, which investigates the therapeutic applications of vagus-nerve stimulation to cure disease.

Dr. Tracey, a neurosurgeon, pursued studies of inflammation after the mysterious death, from sepsis, of a toddler who was in his care. His lab has since revealed molecular mechanisms of inflammation and identified the use of vagus-nerve stimulation to treat it. An inventor on more than 120 US patents and the author of more than 450 scientific publications, he is among the most highly cited scientists in the world. He co-founded the Global Sepsis Alliance, is the author of Fatal Sequence, and is a national and international lecturer.

Please enjoy!

Listen to the episode on Apple Podcasts, Spotify, Overcast, Podcast Addict, Pocket Casts, Castbox, YouTube Music, Amazon Music, Audible, or on your favorite podcast platform. Watch the conversation on YouTube. The transcript of this episode can be found here. Transcripts of all episodes can be found here.

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SELECTED LINKS FROM THE EPISODE

• Connect with Dr. Kevin Tracey:

X | The Feinstein Institutes of Northwell Health | SetPoint Medical | LinkedIn

The transcript of this episode can be found here. Transcripts of all episodes can be found here.

Ulf Andersson

Ulf’s Case Study: VAGUS Smartwatch ECG Test — “Case study: Vagal tone diagnostics with the VAGUS® smartwatch ECG test to detect autonomic nervous system changes triggered by transcutaneous vagus nerve stimulation and oral intake of Famotidine (Pepcid)”

Study of the Transcutaneous Auricular Vagus Nerve Stimulation May Advance Outcome in Chronic Pediatric Inflammatory Diseases by Ulf Andersson

Publications & Media

• The Great Nerve: The New Science of the Vagus Nerve and How to Harness Its Healing Reflexes by Kevin J. Tracey: A groundbreaking book exploring the potential of the vagus nerve to regulate the body’s vital systems and heal medical conditions without drugs.
• STEM-Talk: A bi-weekly interview podcast produced by the Florida Institute for Human and Machine Cognition featuring conversations with groundbreaking scientists, engineers, and technologists.
• Explain Pain by David Butler and G. Lorimer Moseley: An evidence-based book designed for therapists, patients, and students that explains the science behind pain and recovery strategies.
• The Integrative Action of the Nervous System by Charles Sherrington: A classic 1906 work in neuroscience that established fundamental concepts about how the nervous system functions as an integrated whole.

Treatments & Therapies

• Vagus Nerve Stimulation (VNS): A medical treatment that involves delivering electrical impulses to the vagus nerve.
• Audio Chakra Cleanse Soundtracks: A type of alternative therapy mentioned as an example of “nonsense.”
• Biologics: Medications made from living organisms or their components.
• Exogenous Ketones: Ketones that are ingested through a nutritional supplement.
• GLP-1 Agonists (e.g., Ozempic, Mounjaro): A class of medications used to treat type 2 diabetes and obesity.
• Microbiome Transplants: The transfer of fecal matter from a healthy donor to a recipient to restore a healthy gut microbiome.
• TMS (Transcranial Magnetic Stimulation): A noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.
• Focused Ultrasound: A non-invasive therapeutic technology that uses focused sound waves to target and treat a variety of medical conditions.
• Psychedelics (e.g., LSD, 2C-B, Ayahuasca): A class of hallucinogenic drugs whose primary effect is to trigger non-ordinary states of consciousness.
• TENS (Transcutaneous Electrical Nerve Stimulation) units: A non-invasive method of pain relief that uses a mild electrical current.
• Auricular Therapy: A form of alternative medicine based on the idea that the ear is a microsystem which reflects the entire body.
• Famotidine (Pepcid): An over-the-counter antacid that Dr. Tracey describes as a pharmacological vagus nerve stimulator.
• Monoclonal Antibodies: Laboratory-made proteins that mimic the immune system’s ability to fight off harmful pathogens such as viruses.
• Optogenetics: A biological technique that involves the use of light to control cells in living tissue, typically neurons, that have been genetically modified to express light-sensitive ion channels.

Key Concepts & Theories

• Polyvagal Theory: A theory that links the evolution of the autonomic nervous system to social behavior and emphasizes the importance of physiological state in the expression of behavioral problems and psychiatric disorders.
• Heart Rate Variability (HRV): The variation in the time interval between consecutive heartbeats.
• Sympathetic Overdrive: A condition where the sympathetic nervous system is overactive.
• Inflammatory Reflex: A physiological reflex that controls the inflammatory response.
• Bioelectronic Medicine: A field of medicine that uses electronic devices to treat diseases and injuries.
• Blood-Brain Barrier: A highly selective semipermeable border of endothelial cells that prevents solutes in the circulating blood from non-selectively crossing into the extracellular fluid of the central nervous system where neurons reside.
• Cytokines (e.g., TNF, IL-1, IL-6): A broad and loose category of small proteins that are important in cell signaling.
• Cytokine Storm: A severe immune reaction in which the body releases too many cytokines into the blood too quickly.
• Inflammaging: Chronic, low-grade inflammation that develops with advanced age.
• Neuroinflammation: Inflammation of the nervous tissue.
• Neuroplasticity: The ability of the brain to form and reorganize synaptic connections, especially in response to learning or experience or following injury.
• Interoception: The sense of the internal state of the body.
• Engram: A physical trace of memory in the brain.
• M1 and M2 Macrophages: Two different types of white blood cells with different functions in the inflammatory response.

People

• Kelly Owens: A patient of Dr. Tracey’s who suffered from Crohn’s disease and rheumatoid arthritis and was successfully treated with a vagus nerve stimulation device.
• Murthy Simhambhatla: The CEO of SetPoint Medical, a bioelectronic medicine company developing vagus nerve stimulation therapies.
• Dave Chernoff: The Chief Medical Officer of SetPoint Medical, overseeing clinical development of bioelectronic therapies.
• Nolan Williams: A psychiatry professor and director of the Stanford Brain Stimulation Lab who pioneered Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), an FDA-approved treatment for treatment-resistant depression using accelerated TMS.
• Nora Volkow: Director of the National Institute on Drug Abuse (NIDA) who pioneered the use of brain imaging to investigate addiction as a brain disorder and is researching focused ultrasound therapies for addiction treatment.
• Steve Liberles: A professor of cell biology at Harvard Medical School and Howard Hughes Medical Institute investigator who studies the molecular neuroscience of vagus nerve sensory systems and identified specific vagal neuron subtypes that control breathing and digestion in mice.
• K. Frank Austen: A leading expert on asthma research and respiratory medicine.
• Barry Jacobs: A researcher at Princeton University who studied the effects of LSD on cats and contributed to early psychedelic research.
• Andrew Weil: A physician and author with a background in ethnobotany who has written about his experiences with psychedelics including LSD and integrative medicine approaches.
• Ulf Andersson: A retired professor of pediatric rheumatology at the Karolinska Institute and friend of Dr. Tracey’s who used a TENS unit to treat his own inflammation-related depression.
• Paul Nogier: A French physician who created the first auricular acupuncture maps in 1957, pioneering modern ear acupuncture techniques.
• Kenneth M. Ford: Founder and CEO Emeritus of the Florida Institute for Human and Machine Cognition (IHMC), and co-host of the STEM-Talk podcast.
• Geoff Ling: Retired colonel who founded the biology technology office at DARPA.
• Richard Feynman: Nobel Prize-winning American theoretical physicist known for his work in quantum mechanics, quantum electrodynamics, and superfluidity.
• Charles Sherrington: One of the founders of modern neuroscience, known for his groundbreaking work on neural reflexes and The Integrative Action of the Nervous System, for which he won the Nobel Prize in Physiology or Medicine in 1932.
• Santiago Ramón y Cajal: The other founding father of modern neuroscience, known for his pioneering studies of the structure of the nervous system and the neuron doctrine, Nobel Prize winner in Physiology or Medicine in 1906.
• Asya Rolls: A professor who discovered that inflammation in the colon can form a neural network connection to the brain, advancing our understanding of the gut-brain axis.
• Sangeeta Chavan: A colleague of Dr. Tracey’s at the Feinstein Institute for Medical Research, contributing to bioelectronic medicine research.
• Stavros Zanos: A colleague of Dr. Tracey’s at the Feinstein Institute for Medical Research, specializing in neural engineering and bioelectronics.
• Okito Hashimoto: A colleague of Dr. Tracey’s at the Feinstein Institute for Medical Research, working in the field of bioelectronic medicine.
• Eric Chang: A colleague of Dr. Tracey’s at the Feinstein Institute for Medical Research, contributing to neuroscience and bioelectronics research.
• Martine Rothblatt: A friend of Dr. Tracey’s and CEO of United Therapeutics, she is a renowned polymath who founded SiriusXM satellite radio before entering biotechnology to develop treatments for her daughter’s pulmonary hypertension, becoming the highest-paid female CEO in America.
• Lorimer Moseley: Co-author with David Butler of the book Explain Pain and a leading researcher in pain neuroscience and clinical neurosciences at the University of South Australia.
• William Bushell: A scientist who works with the Dalai Lama on studies involving meditation, consciousness, and human potential.
• Elizabeth Blackburn: A scientist who won both the Lasker Prize and the Nobel Prize in Physiology or Medicine in 2009 for her work on telomeres and telomerase.
• Bob Thurman: Uma Thurman’s father and a professor of Tibetan studies at Columbia University, known for his scholarship on Buddhist philosophy.
• The Dalai Lama: The spiritual leader of Tibet and global advocate for compassion, peace, and interfaith dialogue.
• Bill Murray: Formidably funny man and serial-striking bowler.
• Kevin Rose: Probably not the Kevin you’re looking for, but Kevin, by any other name, would smell as sweet.

Institutions & Companies

• SetPoint Medical: A commercial-stage medical technology company that developed the first FDA-approved neuroimmune modulation device to treat rheumatoid arthritis using vagus nerve stimulation.
• Feinstein Institutes for Medical Research: The research arm of Northwell Health and home to 50 research labs, 3,000 clinical research studies, and 5,000 researchers where Dr. Tracey and his colleagues work.
• Karolinska Institute: A prestigious medical research institute and university in Sweden, home to the Nobel Committee for Physiology or Medicine.
• Defense Language Institute: A United States Department of Defense educational and research institution that provides language training to military personnel and federal employees.
• United Therapeutics: A biotechnology company focused on creating innovative products to address the medical needs of patients with chronic and life-threatening conditions, including pulmonary arterial hypertension and organ transplantation technologies.
• Pendulum: A science-backed biotechnology company founded by doctors and scientists that produces next-generation probiotics, including the only commercially available live Akkermansia supplement.
• WHOOP: 24/7 monitoring across sleep, strain, stress, and heart health.
• Oura Ring: A smart ring that monitors over 20 biometrics that directly impact how you feel.
• Fitbit: Wearables designed to “keep you close to your goals, boost your motivation, and show your progress throughout your health and fitness journey.”

Relevant Research & Resources

• Kevin Tracey on Neuro-Immunology and the Treatment of Inflammatory Diseases | STEM-Talk
• Kevin Tracey, MD, Reveals Vagus Nerve’s Power in New Book | Northwell Health
• SetPoint Medical Receives FDA Approval for Novel Neuroimmune Modulation Therapy for Rheumatoid Arthritis | SetPoint Medical
• New Implant Offers Hope for Easing Rheumatoid Arthritis | The New York Times
• I Tried 22 Different Medications Before an Electrical Implant Healed My Crohn’s Disease | Prevention
• Nolan Williams — A Glimpse of the Future: Electroceuticals for 70%–90% Remission of Depression, Brain Stimulation for Sports Performance, and De-Risking Ibogaine for TBI/PTSD | The Tim Ferriss Show
• Dr. Nora Volkow — Director of the National Institute on Drug Abuse (NIDA) | The Tim Ferriss Show
• Reappraising the Role of the Vagus Nerve in GLP-1-Mediated Regulation of Eating | British Journal of Pharmacology
• Role of Vagus Nerve Signaling in CNI-1493-Mediated Suppression of Acute Inflammation | Autonomic Neuroscience
• Good-bye to Drugs? Kevin Tracey, MD on the Bioelectronics Revolution at the Dysautonomia International Conference | Health Rising
• No Audible Wheezing: Nuggets and Conundrums from Mouse Asthma Models | Journal of Experimental Medicine
• Here’s What Happens When Animals Eat LSD | DoubleBlind
• Some Practical Thoughts on Suicide | Tim Ferriss
• The Evolution of Inflammation | Pfizer
• FDA Black Box Warning Raises Awareness of Medication Risk | GoodRx
• Effects of Anti-Inflammatory Vagus Nerve Stimulation in Endotoxemic Rats on Blood and Spleen Lymphocyte Subsets | Inflammation Research
• Vagus Nerve Stimulation for Epilepsy and Depression | Neurotherapeutics
• Vagus Nerve Active during Exercise, Research Finds | The University of Auckland
• Jumping into the Ice Bath Trend! Mental Health Benefits of Cold Water Immersion | Stanford Lifestyle Medicine
• The Thermoregulatory Theory of Yawning: What We Know from over Five Years of Research | Frontiers in Neuroscience
• Prevalence of Autoimmune Diseases Is Strongly Associated with Average Annual Temperatures: Systematic Review and Linear Regression Analysis | BMC Rheumatology
• Nobel Prize Is Awarded to Doctors Who Discovered H Pylori | The British Medical Journal
• What Happens to Your Blood Sugar While You Sleep? | WebMD
• Type A Personality Traits vs. Type B | Simply Psychology
• Focused Ultrasound Neuromodulation of the Spleen Activates an Anti-Inflammatory Response in Humans | Brain Stimulation
• History of Auriculotherapy: Additional Information and New Developments | Medical Acupuncture
• The Medial Surface of the Auricle: Historical and Recent Maps. What Are the Possible Expectations of the “Thumb-Index Technique” | Medicines
• Our Ears Share a Common Ancestry with Fish Gills | Scientific American
• JP Errico Explains How Vagus-Nerve Stimulation Reduces Inflammation and Chronic Diseases | STEM-Talk
• Vagus Nerve Stimulation May Enhance Language Learning, DoD Study Reports | Practical Neurology
• Geoffrey Ling: From DARPA to Life | Twin Global
• Vagus Nerve Stimulation (VNS) Therapy | Epilepsy Society
• The Gut Microbiota Mediates the Anti-seizure Effects of the Ketogenic Diet | Cell
• Dr. Andrew Weil — Optimal Health, Plant Medicine, and More | The Tim Ferriss Show
• The Hidden Flaws of HRV Tracking | The Unlazy Way
• Breathe to Directly Control Heart Rate via Huberman Lab | Instagram
• Famotidine Activates the Vagus Nerve Inflammatory Reflex to Attenuate Cytokine Storm | Molecular Medicine
• WHOOP Adds Psychedelics Tracking | Fitt Insider
• Why Don’t We Know How Antidepressants Work Yet? | Chemistry World
• Ulf’s Case Study: VAGUS Smartwatch ECG Test | VAGUS Health Ltd.
• Study of the Transcutaneous Auricular Vagus Nerve Stimulation May Advance Outcome in Chronic Pediatric Inflammatory Diseases | Medical Research Archives
• Acupuncture Enhances Chances of Pregnancy in Unexplained Infertile Patients Who Undergo a Blastocyst Transfer in a Fresh-Cycle | Chinese Journal of Integrative Medicine
• Acupuncture as Treatment for Female Infertility: A Systematic Review and Meta-Analysis of Randomized Controlled Trials | Evidence-Based Complementary and Alternative Medicine
• Dr. Martine Rothblatt — A Masterclass on Asking Better Questions and Peering into the Future | The Tim Ferriss Show
• Immunoception: The Insular Cortex Perspective | Cellular & Molecular Immunology
• New Science Shows Immune “Memory” in the Brain | Quanta Magazine
• Jennifer Aniston Strikes a Nerve | Nature
• Quantum Physics — His Holiness the Dalai Lama Participates in the 26th Mind & Life Meeting at Drepung | The Office of His Holiness The Dalai Lama

SHOW NOTES

• [00:00:00] Start.
• [00:06:34] Factors alleviating my skepticism about vagus nerve stimulation.
• [00:11:12] SetPoint Medical receives FDA approval for vagus nerve stimulation device to treat rheumatoid arthritis.
• [00:13:24] How Crohn’s disease sufferer Kelly Owens went from a wheelchair to running up stairs in Amsterdam.
• [00:20:36] Placebo effect concerns and the conditions driving my interest in bioelectric medicine.
• [00:25:31] Vagus nerve anatomy 101.
• [00:32:53] Cytokines and inflammation: What happens when the vagus nerve is stimulated.
• [00:33:45] Discovery story: Accidental finding of brain-body inflammation connection.
• [00:35:39] Bioelectronic medicine approach vs. pharmaceutical approach.
• [00:38:18] Mice don’t wheeze.
• [00:40:13] Depression and inflammation connection: SSRIs may work through anti-inflammatory effects.
• [00:42:46] My personal experience with vagus nerve stimulation and mood stability.
• [00:44:22] The pros and cons of inflammation, and how controlling it may lead to even longer lifespans.
• [00:50:56] Weighing the safety of VNS vs. biologics in cytokine suppression.
• [00:56:27] Cold exposure, meditation, and breathing practices affecting the vagus nerve.
• [00:59:01] A population-level increase in chronic inflammatory diseases: Nature vs. nurture.
• [01:00:48] H. pylori: For when you can’t blame stress, God, or the patient for that nagging ulcer.
• [01:03:13] Stress, cortisol, and inflammation connections.
• [01:05:42] SetPoint device vs. non-invasive alternatives for different patient populations.
• [01:11:09] Auricular therapy’s curious French origins.
• [01:13:28] There’s something fishy about this vestigial vagus nerve pathway.
• [01:16:03] Overlapping activation patterns from brain imaging studies of ear stimulation.
• [01:19:01] DARPA support and Geoff Ling’s “What if it’s yes?” attitude.
• [01:21:58] Neurocognition and vagus nerve inputs.
• [01:27:20] How Ulf Andersson turned his depression around with a TENS unit.
• [01:31:55] Heart rate variability complexity and measurement challenges.
• [01:33:05] A breathing exercise for directly controlling heart rate.
• [01:35:30] Using a common antacid as a pharmacological vagus nerve stimulator during COVID.
• [01:36:23] A call for more inflammation-based depression research and patient stratification.
• [01:39:52] SSRIs and anti-inflammatory mechanisms in depression treatment.
• [01:42:20] Interoception: The body’s inflammatory signals reaching the brain via vagus nerve.
• [01:43:22] Ulf’s published protocol for TENS unit ear stimulation.
• [01:44:37] VNS, acupuncture, fertility, and Martine Rothblatt.
• [01:47:16] Chronic low back pain and an inflammatory overreaction analogy.
• [01:48:35] Implications of Asya Rolls’ engram research and inflammation memories in the brain.
• [02:02:35] Cervical TENS vs. true VNS.
• [02:07:12] Charles Sherrington’s reflex theory and nervous system integration.
• [02:12:15] Blue energy meditation and vagus nerve pathways with the Dalai Lama.
• [02:16:47] Parting thoughts: Serious medical conditions vs. self-help approaches.

DR. KEVIN TRACEY QUOTES FROM THE INTERVIEW

“60 million people die on the planet Earth every year. And 40 million of them die from heart disease, stroke, neurodegeneration, Alzheimer’s, Parkinson’s, metabolic syndrome, diabetes, and cancer. So two thirds of the people that die every year on the planet Earth die of those conditions. And that’s according to the WHO. Those conditions all have one thing in common: they’re either caused by inflammation or made worse by inflammation.”

— Dr. Kevin Tracey

“It was just announced that the company SetPoint Medical, which will now be marketing a device to stimulate the vagus nerve to treat rheumatoid arthritis, has received FDA approval. So there’ll be a product launch underway for everything we’re about to talk about in the context of using a medical device that activates an evolutionarily conserved and ancient reflex through which the brain can suppress inflammation when it’s running out of control.”

— Dr. Kevin Tracey

“We’ve discovered that signals travel from the brain through the vagus nerve. … These signals traveling in the vagus nerve are like the brakes on your car. And when you tap those brakes to slow your car barreling down the hill, this device activates what we call the inflammatory reflex.”

— Dr. Kevin Tracey

“If we can find such nerves, then we can build devices to control the nerves, and the devices become the therapy. The bioelectronic medicine story works as long as you know the molecular mechanism, and that’s where people have to be really careful with vagus-nerve stimulation.”

— Dr. Kevin Tracey

“Almost everybody until a hundred years ago, 150 years ago, almost everybody died by the time they were 30. And what happened in the last 150 years can be summarized in a very simple sentence. The human race in the last 150 years removed infection as the leading cause of death. … I think something similar will happen maybe in the next 20 years if we can really understand how to modify inflammation.”

— Dr. Kevin Tracey

“My adage for this thing is, when you don’t understand a disease, think of epilepsy. You start off, you blame God. So they did exorcisms, and that doesn’t work. So if it’s not God’s fault, the next thing you do is you blame the patient. And when you realize it’s not the patient’s fault, in today’s era, oftentimes we find out it’s actually caused, there’s some infectious cause of this thing. And so autoimmune disease may have an infectious cause, it may have an environmental cause. People talk about genetic causes. You inherit some level of risk for autoimmune diseases, but in very few of these conditions do you actually inherit the condition.”

— Dr. Kevin Tracey

Want to hear another episode about the future of electroceuticals and brain stimulation? Listen to my conversation with Stanford’s Dr. Nolan Williams, in which we discussed 70%–90% remission rates for treatment-resistant depression, brain stimulation for sports performance, accelerated TMS protocols, de-risking ibogaine for TBI/PTSD, the future of “electroceuticals,” and much more.