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<\/p>\nIt was the kind of message doctors go into medicine to receive: \u2018Thank you,\u2019 it read, \u2018for saving my life.\u2019<\/p>\n
Its author was Kelly Owens, then 29. From the age of 13, Kelly had lived with the crippling symptoms of two auto\u00adimmune conditions: Crohn\u2019s disease \u2013 an incurable condition that causes severe inflammation in the bowel, leading to pain, fatigue and diarrhoea \u2013 as well as inflammatory arthritis.<\/p>\n
Kelly had been hospitalised more than once and spent years on potent steroids in an attempt to control the inflammation that drove her symptoms.<\/p>\n
Eventually, after more than 15 years of taking these drugs, their side-effects caught up with her and, in her late-20s, she was diagnosed with osteoporosis (a common effect of the steroid prednisone, as it affects the body\u2019s absorption of calcium and increases the rate that bone breaks down).<\/p>\n
The medics who were treating her, though, were out of answers. Prednisone, they said, was all they could offer her.<\/p>\n
Kelly had to give up her career as a teacher as her symptoms worsened, with her legs becoming so swollen she couldn\u2019t walk far \u2013 her husband became accustomed to carrying her on his back if they ventured out and she took a turn.<\/p>\n
The doctor who turned her life around \u2013 the recipient of that heartfelt email sent in 2017 \u2013 was neurosurgeon Dr Kevin Tracey, a world expert in the vagus nerve.<\/p>\n
The vagus nerve is the longest nerve in our body. Running between the base of the brain down to the lower torso, it carries signals between the brain and every major organ, including the heart, lungs and the digestive system, helping to regulate important bodily processes including our heart and breathing rates.<\/p>\n
<\/p>\n
Within weeks of having the device fitted beneath her collarbone as part of her treatment, Kelly Owens was walking without a cane for the first time since she was a teenager<\/p>\n
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<\/p>\n
The vagus nerve has become known as the \u2018super highway\u2019 of the nervous system<\/p>\n
Thanks to its length and reach, the vagus nerve has become known as the \u2018super highway\u2019 of the nervous system.<\/p>\n
But as Dr Tracey told Good Health, its workings are \u2018much more mysterious and beautiful than traffic \u2013 they\u2019re more like the strings, reeds, percussion and soundboards of an orchestra, the 200,000 or so nerve fibres of your vagus vibrate in tune with health\u2019.<\/p>\n
It was Dr Tracey who, in a landmark discovery in the early 1990s, showed that the immune system and brain are linked through our vagus nerve, and that by stimulating the nerve it is possible to treat inflammation.<\/p>\n
He now believes that this technique could also replace weight-loss jabs such as Mounjaro \u2013 but more on that later.<\/p>\n
In autoimmune illnesses, such as Crohn\u2019s, the immune system can \u2018overreact\u2019 to threats, producing too much of a molecule called a cytokine. Put simply, while cytokines are a vital part of our immune response, an excess can tip the body into an inflammatory state and some make people ill.<\/p>\n
Dr Tracey was researching this cytokine response in 1992, in his newly set up lab at the Feinstein Institutes in New York. He and his colleagues were studying an artificial anti-inflammatory molecule they\u2019d developed, CNI-1493.<\/p>\n
Clinical trials had shown that CNI-1493 injections had positive effects on patients with inflammatory bowel disease, reducing inflammation and tissue damage.<\/p>\n
But Dr Tracey and his team then discovered \u2013 unexpectedly \u2013 in studies on rodents, that administering CNI-1493 in the brain also reduced inflammatory cytokines throughout the body. This was despite the fact that the dose administered in the brain was too low to enter the bloodstream.<\/p>\n
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<\/p>\n
Dr Kevin Tracey is a vagus nerve expert<\/p>\n
So how was this happening?<\/p>\n
On a hunch, Dr Tracey repeated the process, but severed the vagus nerve of the mouse they were experimenting on. And this time, despite administering CNI-1493 into the brain, there was no reduction of inflammation in the body.<\/p>\n
The conclusion was a radical one: the vagus nerve regulates the immune system \u2018through an anti-inflammatory healing reflex\u2019, as Dr Tracey writes in his book, The Great Nerve: The New Science Of The Vagus Nerve.<\/p>\n
This in turn meant that \u2018it should be possible to regulate inflammation with devices that stimulate the vagus nerve in patients\u2019.<\/p>\n
This was a groundbreaking thought at the time, for while nerve stimulation devices have been used since the 1980s to prevent seizures in people with severe epilepsy (by dampening down irregular electrical activity in the brain), this was the first time it had been suggested for inflammatory diseases.<\/p>\n
Dr Tracey then set up a company, Setpoint Medical, to develop a device to stimulate the vagus nerve using electrical impulses to treat inflammation.<\/p>\n
Kelly, who lives in New Jersey in the US, came across Dr Tracey\u2019s work online and contacted him following a flare-up of her Crohn\u2019s in 2015 that left her so malnourished and emaciated she had to be admitted to hospital for 12 days, receiving fluids, nutrients, steroids and morphine via a drip.<\/p>\n
She\u2019d seen a video of Dr Tracey discussing his research on the vagus nerve and how it could be used to treat people with autoimmune conditions \u2013 and, in 2017, she joined a clinical trial his research company was running.<\/p>\n
A small device \u2013 about the size of a muffin \u2013 was implanted in the chest wall beneath her collarbone, with a lead threaded up her neck and attached to the vagus nerve: it was programmed to be activated two or three times a day for several minutes only to dial down the inflammation. (Essentially it inhibits inflammation in the spleen with the effect then spreading throughout the body, including the joints, Dr Tracey explains.)<\/p>\n
Within weeks, Kelly was walking without a cane for the first time since she was a teenager. Eight weeks later, her gastrointestinal symptoms had vanished. A few months later, she was steroid-free.<\/p>\n
\u2018Kelly still has the device and is doing extraordinarily well, both personally and professionally,\u2019 Dr Tracey says, describing Kelly\u2019s hobby of building custom guitars \u2013 an astonishing achievement for someone who previously suffered crippling pain in her hands, fingers, elbows, jaw, shoulders, back, hips, knees, toes and ankles.<\/p>\n
And he is emphatic: \u2018Kelly\u2019s remarkable clinical improvements are due to vagus nerve stimulation (VNS) and underscore the promise of bio\u00adelectronic medicine.\u2019<\/p>\n
It\u2019s a promise that\u2019s been recently recognised by the US medical regulator, the FDA, which approved the Setpoint implant for people whose rheumatoid arthritis is not being controlled well enough by medication.<\/p>\n
This followed a landmark trial that showed significantly more patients given the implant experienced improved symptoms compared with a control group.<\/p>\n
In fact, it could be said that the vagus nerve is having something of a \u2018moment\u2019, as millions of social media hashtags proclaiming its importance testify.<\/p>\n
Meditation, Wim Hof-style ice baths and deep breathing to achieve a sense of calm are all based on vagus nerve stimulation.<\/p>\n
However, less well known, perhaps, is research such as Dr Tracey\u2019s which has identified a link between vagus nerve stimulation and easing digestive conditions such as Crohn\u2019s and IBS.<\/p>\n
And he now believes VNS, rather than GLP-1 injections, is the future for weight loss.<\/p>\n
As he told Good Health: \u2018GLP-1 injectable drugs such as Mounjaro and Ozempic have changed the field of medical weight loss, but [the] underlying mechanism actually relies on neural signalling through the vagus nerve.\u2019<\/p>\n
So how does this work?<\/p>\n
Each fibre of the vagus nerve plays a part in co-ordinating our bodily processes, including digestion and the absorption of nutrients \u2013 in this case, via receptors in the stomach and intestines.<\/p>\n
The vagus also helps the liver regulate blood sugar levels, \u00adcourtesy of the portion of the nerve that connects to it. At the same time, another part of the nerve linked to the pancreas \u00adregulates the release of insulin.<\/p>\n
These all contribute to our body maintaining a healthy weight and blood sugar levels.<\/p>\n
Dr Tracey explains that while research is ongoing, the evidence already points to \u2018GLP-1 injections\u2019 ability to curb appetite and decrease blood glucose depends on activating vagus nerve circuits that tell the brain and liver to regulate metabolism.\u2019<\/p>\n
He points to a key trial involving patients who\u2019d undergone surgery where the vagus nerve is cut to reduce the production of stomach acid (used to treat people with stomach ulcers, for instance).<\/p>\n
When they were then given GLP-1s, the drugs had no effect on their food intake, unlike a control group of patients who\u2019d also been given the drugs but not had the surgery.<\/p>\n
Similarly, while GLP-1s work by slowing down stomach emptying (which helps people feel full sooner), the surgery group did not experience this, unlike the control group.<\/p>\n
\u2018I expect in future some patients will swap their injections for bioelectronic devices,\u2019 says Dr Tracey.<\/p>\n
The great advantage of such devices, he says, is that they are almost entirely free of side-effects, unlike GLP-1 injections which can cause digestive problems such as constipation, nausea, diarrhoea \u2013 and, in extreme cases, pancreatitis.<\/p>\n
\u2018When you take a drug it goes everywhere, hence side-effects,\u2019 adds Dr Tracey. \u2018Nerve fibres, however, are specific and go in one direction to a specific place for a specific function. So it should be possible to selectively stimulate the vagus nerve fibres someday, to have the benefits without the side-effects.<\/p>\n
\u2018Where GLP-1s require life- long administration and have been linked to muscle loss and unpleasant symptoms, activating the vagus nerve may address obesity without those adverse effects.\u2019<\/p>\n
(The risk of overstimulating the nerve is minimal, says Dr Tracey, who points out that such treatment has been effectively used for epilepsy for many years. Potential side-effects include changes in the patient\u2019s voice during the active stimulation and twitching of the lip or neck muscles.)<\/p>\n
\u2018My clinical vision is for devices to supplant GLP-1 injections \u00adaltogether,\u2019 he says.<\/p>\n
\u2018Realistically, such vagus nerve activating devices for obesity and weight management could be widely available within the next five to ten years, given current progress and investment in \u00adbioelectronic medicine.\u2019<\/p>\n
Indeed, in terms of targeting the vagus nerve to harness these effects, it may not require an implantable device at all.<\/p>\n
In 2021, Dr Tracey published a study in the journal Scientific Reports which, excitingly, showed VNS could potentially help tackle obesity \u2013 but instead of a pacemaker-style device like Kelly had, in their experiments on mice they used focused ultrasound.<\/p>\n
This is a type of ultrasound directed into the body in a \u00adconcentrated manner towards a precise target \u2013 in this case, where the vagus nerve meets the liver.<\/p>\n
After experimenting on 100 mice for 16 weeks, their study showed that focused ultrasound not only caused significant weight loss and reduced inflammatory cytokines, but also tackled belly fat.<\/p>\n
(Little wonder that this paper is among the top 2 per cent of scientific papers read or cited by other researchers.)<\/p>\n
Dr Tracey explains that the focused ultrasound appears to activate vagus nerve fibres in the liver \u2018that convey satiety signals to the brain. Enhancing these \u00adsignals induces a feeling of \u00adfullness more quickly\u2019.<\/p>\n
Dr Ahmed Albusoda, a consultant gastroenterologist at Royal London and Whipps Cross Hospital, also has high hopes for the use of VNS in treating gut conditions. A review of studies, which he published in the Journal of Anatomy in 2020, found that VNS can reduce pain, including in the gut.<\/p>\n
His team also ran experiments showing that stimulating the vagus nerve could potentially ease IBS pain. He sees VNS as potentially being \u2018like physiotherapy for the nervous system\u2019.<\/p>\n
He, though, is cautious about the benefits for weight loss: \u2018The vagus nerve does play a role in satiety \u2013 the sense of fullness after eating \u2013 and early research \u00adsuggests that stimulating certain branches of it can influence gut hormones,\u2019 he says.<\/p>\n
\u2018But at the moment, VNS isn\u2019t remotely as powerful or predictable as GLP-1s. And while there\u2019s research into stimulating parts of the bowel to trigger the body\u2019s own GLP-1 release, sometimes using electrical impulse, this remains experimental.\u2019<\/p>\n
That said, it appears that VNS is potentially a very powerful tool. So why isn\u2019t it being widely used?<\/p>\n
Part of this is down to the fact that the research into it is ongoing \u2013 Dr Tracey says that \u2018an avalanche of promising new data is barrelling down the mountain\u2019 \u2013 and approval from regulatory bodies such as the FDA will not happen without further proof.<\/p>\n
There is also the fact that there is little profit motive for drug companies to push this new \u00adtechnology, he adds.<\/p>\n
Dr Albusoda sees further \u00adchallenges, including the \u2018dose\u2019.<\/p>\n
\u2018How strong the pulse should be, how long it should last and where exactly to apply it,\u2019 he says. \u2018Until studies become standardised, comparisons are difficult.\u2019<\/p>\n
And \u2018it is imperative we map the vagus nerve fibres, establishing which parts affect each part of the body\u2019, adds Dr Tracey.<\/p>\n
Dr Albusoda says that, despite the hurdles and significant research still to conclude, \u2018the \u00adevidence is building that the vagus nerve influences pain, inflammation and digestion\u2019.<\/p>\n
He believes that even now: \u2018I\u2019d like more clinicians to consider vagal function when treating \u00adconditions such as IBS,\u00ad anxiety-related gut symptoms and chronic pain \u2013 rather than seeing these problems as purely \u201cin the head\u201d or \u201cin the gut\u201d,\u2019 he says.<\/p>\n
\u2018But with artificial intelligence helping to fine-tune stimulation patterns, I expect the next decade to bring \u00adpersonalised electroceuticals \u2013 gentle, data-guided electrical therapies that could sit alongside medicines rather than replace them.\u2019<\/p>\n
The future of medicine, then, could lie not in treating symptoms with drugs, but tackling a cause that \u00adpotentially lies with our vagus nerve.<\/p>\n
DIY vagus nerve stimulation<\/p>\n
How do you know if your vagus nerve is happy? One key sign, says neurosurgeon Dr Kevin Tracey, is a healthy heart rate, which you can check by checking your pulse (healthy is 60-100 beats per minute). This is known as having high vagal tone.<\/p>\n
Signs of \u2018low vagal tone\u2019 include being stressed or anxious; you could also have digestive issues such as acid reflux, or raised blood pressure, fatigue and brain fog.<\/p>\n
Another way to assess \u2018vagal tone\u2019 is by measuring heart rate variability (HRV) \u2013 this is the variation in time between individual beats.<\/p>\n
This can be done in a hospital setting with an ECG machine, or with a smartwatch or similar (however, experts note that the accuracy of a watch depends on the fit to your wrist). The higher your HRV, the happier your vagus nerve, and \u2013 generally \u2013 the healthier you are, it seems.<\/p>\n
Dr Tracey is evangelical about the impact of exercise on the vagus nerve, suggesting it may help by \u2018increasing the vagus nerve signals that activate brain regions associated with enhanced positive emotions \u2013 and suppressing depression-causing inflammation\u2019.<\/p>\n
He also says that cold-water exposure, meditation and deep breathing all contribute to a healthy vagus nerve, possibly by their impact on the diaphragm, which affects the nerve.<\/p>\n","protected":false},"excerpt":{"rendered":"It was the kind of message doctors go into medicine to receive: \u2018Thank you,\u2019 it read, \u2018for saving…\n","protected":false},"author":2,"featured_media":563620,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[92,2460,105,16,15],"class_list":{"0":"post-563619","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-dailymail","9":"tag-fda","10":"tag-health","11":"tag-uk","12":"tag-united-kingdom"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@uk\/115531262016808278","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/563619","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/comments?post=563619"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/563619\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media\/563620"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media?parent=563619"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/categories?post=563619"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/tags?post=563619"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}