“The best cure for the body is a quiet mind.” - Napoleon Bonaparte

The data behind VAGUS NERVE STIMULATION: the most under-appreciated discovery.

All animals have a neurological system. However, this system is made up of many parts that have evolved over millennia and are now integrated into one.

While I would love to discuss each part, today I will briefly focus on one in particular that may be closely related to many diseases involving the spine: the parasympathetic system. This nervous system works in the background, outside of our conscious awareness, and is crucial for functions such as breathing, digestion, resting, relaxation, and even normal sexual function. More recently, an interesting observation has been made - the parasympathetic system also appears to regulate the immune system.

Unlike the nervous system, the immune system is a bloodborne, cellular organ that helps us fight infections and cancers. However, sometimes the immune system can attack its own body, as seen in rheumatoid arthritis (RA) where the immune system attacks joints, causing pain and dysfunction.

In the US alone, there are 1.3 million adult cases of rheumatoid arthritis, and unfortunately, there are many other autoimmune diseases in addition to RA. To treat the severe autoimmune effects of RA, powerful medications are prescribed that inhibit the overall immune response.

While these medications can improve symptoms, they also render the patient immunocompromised and can have long-term side effects such as severe osteoporosis. In some cases, even strong medications are insufficient to control the symptoms of autoimmune diseases.

In the last decade, neurosurgeons have discovered a mechanism by which the brain communicates with the immune system and have used this mechanism to reduce and treat severe autoimmune responses.

Let us now follow the story of how this discovery came to be. One of the diseases that neurosurgeons treat is epilepsy, and one of the procedures used is vagal nerve stimulation. The vagus nerve, which emerges from the brain stem, descends through the skull base, travels with the carotid artery in the neck, and disseminates throughout the body. It is one of the primary pathways for the parasympathetic system to exert control over the body.

It was discovered that placing a vagal nerve stimulator in the neck can control severe epilepsy for patients who are already on maximum medication and still experience frequent seizures. Over 100,000 patients have been treated with vagal nerve stimulation, with excellent results in treating their epilepsy. By chance, some of these patients also had rheumatoid arthritis, and it was observed that their arthritis dramatically improved after the vagal nerve stimulator was placed.

This observation led to many experiments in the laboratory, involving animals, to understand the pathways involved. The pathway is now known as the inflammatory reflex, and it is largely mediated by the vagus nerve. Multiple experiments have shown that stimulating the vagus nerve significantly reduces cytokine production and disease severity in rheumatoid arthritis, colitis, sepsis, and endotoxemia.

A pivotal study conducted in humans in 2016 (Koopman FA, PNAS 113 (29) 8284-8289 July 5, 2016) clearly demonstrated that stimulating the vagus nerve significantly improves symptoms in rheumatoid arthritis patients. This study also helped elucidate the mechanism behind the response: the drop in cytokines and tumor necrosis factor is a direct result of vagal nerve stimulation.

Equally significant is the length of stimulation required for long-term reduction in autoimmune activity. Vagal nerve stimulation for epilepsy is turned on for up to 240 minutes per day, while for autoimmune response, it is only applied for one to four minutes per day. It is fascinating that just one minute of vagal nerve stimulation in a 24-hour period can lead to dramatic decreases in autoimmune response.

The fact that the vagus nerve, and by extension the brain, can control the immune system with such long-term impact is highly significant. Vagal nerve stimulation, and the subsequent increase in vagal tone, has a profound impact on the immune system. The immune system is crucial for surviving infections and is also involved in the prevention and treatment of cancer. However, the exact impact of vagal tone on diseases such as arthritis, colitis, and cancer is still unknown.

Nevertheless, I personally believe that there is a connection here, and we should continue to explore the possibilities presented to us. Currently, placing a vagal nerve stimulator for anything other than epilepsy is purely experimental. However, there is a way to increase vagal tone that is accessible to everyone: meditation. While there are no conclusive studies showing that meditation alone can alleviate severe inflammatory diseases, there are no significant downsides either.

Considering the significant impact the immune system has on overall health, finding an accessible pathway to improve it seems like a no-brainer. It is worth noting that in the experiments mentioned above, vagal stimulation was applied for just one minute per day. This suggests that even a brief course of vagus nerve stimulation, or a brief increase in vagal tone through meditation, could have long-term beneficial effects on the immune system.