A parasympathetic panacea via our vagus nerves?

We could use that right about now.

It’s Monday. We are looking up at this week’s Sysiphean mountain. On the horizon in two weeks looms a massive event in the history of these United States, and in the history of democracy versus autocracy.

We are hardwired to pay special attention to fearful things. War, disease, climate change, fascism. Bills to be paid, kids to raise, votes to be counted. Pains, palpitations, dizziness. A creeping sense of our own fragility and mortality. And yet we are also hardwired to find calm between the storms, to find a sense of tranquility amid the chaos. As this very consequential election looms in America, and as we continue to face adversity in our daily lives, I’m reminded of the power of the deep breath and the walk in the woods, the vagus nerve and the parasympathetic nervous system.

The sympathetic nervous system is all about “fight or flight.” Hypothalamus, epinephrine, cortisol.

The parasympathetic nervous system is all about “rest and digest.” Medulla, vagus nerve, acetylcholine.

I thought this introduction to the vagus nerve as a prime conduit of mind/body/parasympathetic integration was instructive. Via Quanta Magazine:

The capabilities of the brain alone are astonishing. The supreme organ gives most people a vivid sensory perception of the world. It can preserve memories, enable us to learn and speak, generate emotions and consciousness. But those who might attempt to preserve their mind by uploading its data into a computer miss a critical point: The body is essential to the mind.

How is this crucial brain-body connection orchestrated? The answer involves the very unusual vagus nerve. The longest nerve in the body, it wends its way from the brain throughout the head and trunk, issuing commands to our organs and receiving sensations from them. Much of the bewildering range of functions it regulates, such as mood, learning, sexual arousal and fear, are automatic and operate without conscious control. These complex responses engage a constellation of cerebral circuits that link brain and body. The vagus nerve is, in one way of thinking, the conduit of the mind.

Like a grand old tree the vagus nerve sends its branches and roots deep into the substance of our bodies, helping to conjure and control our sense of being. Indeed it is the longest nerve in the body, and we would be unwise to discount that implied importance. Early anatomists called it “vagus,” from the Latin for “wandering.”

We have all been through some stuff. Some damaging, disheartening, disequilibrium-inducing stuff. My early forties involved the seeming expiration of warranties in my body, with some disturbing symptoms and medical possibilities. The worst pandemic in a century hit, and there were times I thought I might be among the souls who wouldn’t make it through.

But as I close in upon a half century of my own, I’ve cobbled together a few techniques and routines that help. If I had to pick the two most important ways I try to light up my parasympathetic nervous system (and other pathways/neurotransmitters associated with wellbeing) I would choose breathing and exercise.

Does that seem too simple? For the morbidly rich, apparently so. Some spend over $20,000 a week to attend wellness retreats like the joint venture between the Mayo Clinic and Three Forks Ranch in Colorado. Here they do “medical screenings” and personalized nutrition and exercise sessions, lectures on topics like sleep and happiness, time in nature, and a “kitchen academy” to learn how to prepare healthy meals.

On a much smaller scale we are bombarded with ways to chill so often that the true imperative of self-care becomes a tired cliché. Old adages are rebranded as “vagus nerve resetting” and “vagus nerve exercises.” TikTok alone has 13,800 videos on #vagusnerve that you can watch as of this writing. So please think of the following reminders not as shortcuts to happiness or deliverance from all anxiety, but rather as coping tools that can help us coexist with anxiety, stress, and discomfort.

Recall that the sympathetic nervous system is all about “fight or flight.” The parasympathetic nervous system is all about “rest and digest.”

These yin/yang systems make up the larger umbrella of the autonomic nervous system, and there can be an imbalance between them. This can be driven by chronic stress and bad lifestyles. That balance is often referred to as “tone", and I personally want to increase my parasympathetic tone.

What does increasing our parasympathetic tone do? What lightning bolts can our vagus nerve channel? Remember, nothing is a panacea. But greater parasympathetic tone helps with at least this dozen:

1. Stress reduction:

• Lowers cortisol levels, promotes a sense of calm and relaxation

2. Cardiovascular health:

• Reduces heart rate, lowers blood pressure, improves heart rate variability

3. Digestion:

• Increases blood flow to the digestive system, stimulates digestive enzyme production, improves nutrient absorption

4. Sleep quality:

• Facilitates easier transition to sleep, promotes deeper, more restorative sleep

5. Immune function:

• Reduces inflammation, enhances overall immune response

6. Emotional regulation:

• Helps manage anxiety and depression, promotes emotional stability

7. Cognition:

• Improves focus and concentration, enhances memory formation and recall

8. Pain management:

• Reduces perception of pain

9. Metabolic regulation:

• Supports healthy insulin sensitivity, aids in maintaining a healthy weight

10. Recovery from stress and exercise:

• Accelerates physical recovery, improves mental recuperation

11. Respiratory function:

• Promotes deeper, more efficient breathing, can help manage respiratory conditions

12. Overall well-being:

• Contributes to a greater sense of balance and health

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“When you feel like life is out of focus, always return to the basics of life—breathing. No breath, no life.”

Mr. Miyagi, The Karate Kid

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So how can we increase parasympathetic tone in our bodies? Like I wrote above, right now I’m prioritizing deep breathing (because it’s quick and easy, and I feel its effects within minutes) and exercise (because right now I can still rotate between activities that cause rotating aches and pains). You know the following list. But with the assuredly stressful two weeks coming up, a potentially disastrous 4 years looming, and an assuredly stressful-at-times-life ahead of us all… why not consider each clichéd one again:

1. Deep breathing exercises:

• I wrote about this in another post entitled Cold hands, warm and stressed heart. Here’s a quote: “Deep breaths. Like taking 5 seconds to breathe in, and then 6-7 to breathe out. Within a minute this can magically tame the sympathetic tone in our whole bodies, and we feel a vital warmth returning to the outposts of our cold hands and fingers. With so many nerve endings concentrated in our fingertips, this warming has an outsized effect on our sense of wellbeing.

  With some practice, we can even take these breaths inconspicuously while talking to other people. We might find this makes us better communicators, too. It forces us to listen. We can try to speak more slowly and deliberately, resisting the pressured urge to spill everything out quickly before the visit ends, the dinner is over, or the other person’s attention is lost to a cell phone yet again. Speaking slowly and deliberately is another magic trick that can warm the hands.”

2. Regular exercise:

• For those who can exercise, from puttering around the house to walking to running and lifting weights, whatever amount of exercise we can incorporate into our daily lives has been pretty universally shown to be net positive. I don’t think anyone has missed this. So I’ll add something pithy and overlooked. I think shadowboxing is an amazing exercise. I like that we can paradoxically subdue the fight-or-flight impulse with an exercise that mimics the fight. Previously I wrote: “…while boxing is a bloody sport with the potential for all sorts of injuries and harm in the short and long term, shadowboxing instead combines the balance, agility, strength, fitness, confidence, and stress reducing benefits… without all the head traumas. It can be practiced anywhere, and almost anytime. Work outs can be 60 seconds long, or 45 minutes while watching Family Feud. And if we want to battle some demons, all we need is a source of light to throw a shadow on a wall, or a reflective surface to create an immediate sparring partner.

  Is it goofy telling people that shadowboxing makes for a worthy exercise of the body and mind? You tell me. Or we can always ask Mike Tyson if it’s silly.”

  The increased parasympathetic tone kicks in after exercise, with lower resting heart rate, blood pressure, and stress neurophysiology.

3. Meditation and mindfulness practices:

• I’m guilty of doing these only when I’m struggling. But I wrote about working on our anxiety and depression tendencies before they become a problem in my New Years Resolutions for 2023: “If you’re fortunate enough to be in a good place right now, but have had the experience of not being in a good place before, now is the time to build your fortress against mental health problems. Like the little pig who builds his house out of bricks, or the ant who works hard all summer and gathers food for the winter, there are many parables about preparing and fortifying ourselves when it seems like there is no immediate need.” If you are prone to anxiety might I recommend a little mom and pop site called Meditation Oasis. It’s mostly free, or you can throw a little support to the creator Mary Maddux, MS, HTP. She brings over 50 years of meditation practice and teaching to the creation of guided meditations and music. My favorite one is her meditation entitled “Rest in Stillness.”

4. Yoga:

• I love the idea of yoga as it incorporates exercise, breathing, mindfulness, and stretching. But in reality I end up howling with each pose as my innate inflexibility is painfully exposed and I am politely asked to leave the class. But I love the idea of yoga, and encourage anyone who can do this to keep it up.

5. Progressive muscle relaxation:

• Progressive muscle relaxation activates the parasympathetic nervous system by systematically tensing and then relaxing different muscle groups, which signals the body to shift into a calmer state. To practice it, start by tensing a specific muscle group (like your fists) for 5-10 seconds, then release the tension and focus on the sensation of relaxation for 15-20 seconds, gradually working through all major muscle groups from head to toe.

6. Spending time in nature:

• If you are fancy this is called shinrin-yoku. Here’s a post I wrote about forest bathing in response to another great post by Dr.

  Cassandra Quave
  . I wrote about some of the risks of being in the forest, kind of tongue in cheek, and then spent the rest of the article reviewing benefits like mindfulness, increasing parasympathetic tone, appreciating beauty, cultivating a sense of awe, the color green, walking as exercise, and proven benefits in terms of the immune system and natural killer cells. The beneficial overlaps here are obvious. Would you accept a prescription for shinrin-yoku from your doctor?

7. Adequate sleep:

• Another self evident one. Are you struggling with insomnia? Here is a post I wrote and that I often share with my own patients when they want a deep dive on evidence based ways to improve sleep. Aim for 7 hours, and don’t obsess about rest versus sleep. I also wrote about the mysteries of the glymphatic system in our brains, and how this dishwasher cycle might work best when we sleep in the side position.

8. Proper nutrition

• We are what we eat, and I can imagine diets full of junk and sugar messing with out entire bodies, and the vagus nerve as a two way conduit running throughout the body does not appreciate junk food. That’s a non-scientific statement, but I’m stating it anyway. Here’s a deep dive I wrote about nutrition and the actual evidence for what’s best to eat specifically to reduce cardiovascular risk.

9. Massage

• Trading with family members or close friends is perhaps the best way to get a massage back. Or we can see a massage therapist and pay.

10. Cold water exposure?

• We see this trend popping up right now. Cold water plunges do stimulate the parasympathetic nervous system, and one of my friends swears that he actually “feels high” after doing his weekly plunge into frigid waters at his health club. I worry about the sudden, reflex vasoconstriction that can occur with the cold shock response, and the real potential to trigger arrhythmias and heart attacks. Like shoveling snow, too. I don’t recommend this one. Need more information on risks and benefits across age groups and problems.

12. Vagus nerve stimulation techniques

• Studies are being done to try to hack the vagus nerve directly, and have shown some benefit in terms of treatment-resistant depression and epilepsy. This is beyond the scope of this post, but a quick primer can be found at Mayo Clinic.

13. Social connection and positive relationships

• I think this is another self-evident one. Many studies have correlated social connection with longevity, happiness, and wellbeing. Parasympathetic stuff. Social lives are also one of the ways we can help preserve our cognition and memory, as this post about evidence-based ways to sustain the brain details. And when we think about how to be a better friend, when is the last time you asked someone if they wanted to be helped, heard, or hugged?

14. Listening to calming music:

• I like Chopin, Khruangbin, and Big Thief right now. What are your favorites? Listening to calm music typically reduces heart rate, lowers blood pressure, decreases stress hormone levels, and promotes relaxation throughout the body.

15. Caution with caffeine:

• For some people caffeine produces only mild sympathetic nervous system effects, but for others it can be like pouring gasoline on a fire. Caffeine can worsen anxiety, palpitations, insomnia, and hyperhydrosis of the armpits. Alcohol has mixed effects, but as it wears off it can trigger sympathetic nervous system activity.

16. Laughter and humor:

• I’ll end this post with a quote from one of my older patients. When I asked him how he made it to the age of 86, among the many reasons he cited this one first and foremost: “My wife and I have always made each other laugh. She cracks me up, and I do the same with her.” The folks in my practice who have had the most success with longevity spontaneously cited a lot of the above parasympathetic nervous system techniques. I just realized this as I write this post 2 years later.

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I hope this post helps you on a Monday in October that is just 15 days from a voting event that has many of us nervous. Add that sympathetic nervous system imbalance to our daily concerns and we can start feeling pretty anxious and off balance. Recalibrating our parasympathetic tone can be done within minutes, temporarily, but I believe that with consistency we truly can rewire our brains and the massive neural conduit of the vagus nerve throughout our bodies to some degree. Hopefully TikTok videos and posts like mine do not make this into another cliché. Nor do we need dismissive types casting shade on the intuitive and soft power of breathing, exercising, and chillaxing.

Return to your breath.

Take good care.