While anatomy doesn't change - trends and buzzwords do. Being an acupuncturist and massage therapist, social media algorithms tend to push the new trendy solutions to common health issues. Currently, my algorithms are very keen on showing me all the ways to 'hack' my vagus nerve. While I understand how multifaceted the nerve is, what piqued my interest on this topic was the variety of methods people were insisting were the best way to soothe the vagus nerve - and for such a variety of reasons. The methods ranged all the way from pulling your ear lobe to reduce anxiety, to humming to solve your IBS - and everything in between. So to jump on the bandwagon, I thought I would explore some of these ideas, and give an overview of what the Vagus nerve is - what it does - and how it relates to acupuncture and massage.
What is the Vagus Nerve?
The cranial nerves are a set of 12 nerves that send electrical signals between your brain and your head and torso. These nerves transmit sensory and motor information such as smell, taste and muscle movement.
The vagus nerve is the 10th cranial nerve. From the brain it branches off to supply nerve function to the tear ducts, eyes, salivary glands, the heart, the lungs, the liver, the gallbladder, the stomach, the spleen, the pancreas, the large and small intestine, the rectum, the kidney, the bladder, and the penis and scrotum/uterus and ovaries. Quite clearly it has a particularly diverse set of functions, so it's understandable that it gains a lot of attention in health discussion.
The Parasympathetic Nervous System & The Vagus Nerve
The parasympathetic nervous system is the part of the nervous system we relate to being calm, happy, and healthy. It's often referred to as the 'rest and digest' part of the nervous system as when it's stimulated, our body can carry out these functions well. Conversely, the sympathetic nervous system is related to our 'fight or flight' response, increasing stress hormones and heart-rate, and diverting blood away from our digestive system to our muscles so we can fight or run away quickly. In Acupuncture terms, the parasympathetic nervous system is Yin, and the sympathetic nervous system is Yang. Two systems work together to create balance throughout the body, favouring rest and digest when appropriate, and fight or flight when needed.
How is this related to the Vagus nerve? Simply, the Vagus contains three-quarters of your parasympathetic nervous system’s nerve fibers, so the two are fairly synonymous. These nerve fibers send information between your brain and other parts of the body, creating the following functions:
Eyes: Constricts the pupils - Improves close-up vision - Creates tear production
Nose & Mouth: Stimulates saliva - Stimulates production of snot
Lungs: Tightens airways to reduce the amount of work the lungs do when resting
Heart: Lowers the heart rate and contraction force
Digestive System: Increases peristalsis, speeding up digestion - prompts insulin release from the pancreas aiding digestion.
Lower Digestion: Relaxes the muscles that allow us to go to the loo.
Reproductive System: Controls arousal of reproductive organs.
It's worth noting that these functions are, for the most part, involuntary - ie we don't consciously ask our bodies to perform these functions, they happen naturally and involuntarily.
Other functions of the vagus nerve include:
Immune system responses
Mood
Skin and muscle sensations
Speech
Taste
What happens when the vagus nerve goes wrong?
Before we explore the symptoms, it's worth recognising the causes of vagus nerve dysfunction. Most causes are related to trauma to the nerve itself - This could be from a neck injury, or poor neck posture such as the Upper Cross Syndrome, which causes compression to the nerve as it exits the brain and transverses the neck. It could also be from abdominal surgery where the nerve is accidentally cut in the area it connects to the digestive system. It can also become impaired due to chronic inflammation, infections or illnesses such as diabetes.
Aside from physical effects on the nerve, it is also known that it can be affected by prolonged stress. It seems more like stress further exacerbates a vagus nerve dysfunction rather than causes it, however, stress is known to cause muscle tension and postural changes to the neck area so it could be indirectly influencing the health of the vagus nerve. As stress and anxiety are more associated with the sympathetic nervous system, it could also be argued that if the 'rest and digest' functions of the parasympathetic nervous system aren't firing, the 'fight and flight' functions of the sympathetic nervous system are more likely to be prevalent - increasing levels of stress and anxiety. By this notion, stress and anxiety could be a cause or effect of an impaired vagus nerve.
Given the areas the nerve serves and its relationship with stress and anxiety, many of the symptoms make perfect sense:
Symptoms include:
Balance issues and Dizziness
Chronic Stress and Anxiety
Fatigue
Digestive issues
Abdominal bloating
Acid reflux
Dysphagia (difficulty swallowing)
Weak voice
Sleep issues
Immune issues
Brain fog
Migraines
Vasovagal syncope (fainting)
This is a wide range of symptoms, most of which can be caused by an array of issues, not just the vagus nerve. One of my issues with the current trend is that this is not made clear, and each profile of a vagus nerve release method tends to focus on just one or two symptoms. Many attempt to convince you that if you have this particular symptom, then it is the vagus nerve and their solution is infallible, without discussing any other potential explanations or solutions.
In acupuncture training, we work a lot with 'differential diagnosis'. This is trying to obtain as much information from a patient as possible in order to be confident with our diagnosis and rule out other potential issues. For example, if someone came for treatment with fatigue, we would find out what makes it better or worse, if it has any triggers such as activity, time or day, periods or eating habits; and what other symptoms accompany the fatigue - for example headaches, insomnia or shortness of breath. The potential options are endless with this example, but the point is that the treatment would differ greatly depending on what answers were given. We would also be able to rule out other issues, and our diagnosis, advice and treatment would be tailored to your individual set of circumstances.
All this said, being confident with a diagnosis of vagus nerve dysfunction is difficult as you would likely experience just one symptom depending on which area of the nerve was affected. This means that ruling other causes of the symptom is often the way to semi-confidently suggest vagus nerve dysfunction. Diagnosis can be achieved by looking at the nerve via MRI, assessing heart function via an ECG, or using a smart pill to analyse your stomach and intestines. As these tools are not readily available to most health practitioners, acupuncturist or otherwise, it makes diagnosis quite tricky.
Reviewing the Vagus Nerve Hacks
Here are the vagus nerve 'hacks' I have come across to date in no particular order:
Occipital massage - massaging medically and laterally
Vagus Nerve Stimulation (VNS) - Electrical stimulation of the Vagus Nerve
Meditation
Massage above the top of the sternum
Gargling, sucking and humming
Taking an ice bath
Taking Probiotics
Deep breathing in the prayer position
Colon massage
Pushing on the trapezius muscle, then rotating your head, looking up and squatting
Tapping Kidney 27 acupuncture point
Waving arms around
Carrying out the full range of movement of the neck
Pulling your earlobe down
Get up early and tell yourself you love yourself
Focussing on something near and then something far away
Rolling a ball under the foot
Looking at the long list of methods to correct vagus nerve dysfunction, it's clear that most are based on manipulating an area of the body on the pathway of the vagus nerve. These include occipital massage, gargling, sucking and humming, pushing on the trapezius muscle, neck range of movement and pulling the ear lobe. On the basis of location, these methods make some sense, though it's difficult to gauge the effectiveness of the action and influence on the nerve for some of these methods.
Other methods provided some explanation, for example one claimed that probiotics create stimulation of the nerve through the gut, and unhealthy guts create inflammation which irritates the vagus nerve. Another suggested that changing your focus from near to far activates the oculocardiac reflex which calms vagus nerve. I'm in no position to confirm or deny these claims, but they seem to be based on some kind of logic.
Helpfully, the Health Science Institute (HSI) has done some research into the claims of some of the main vagus nerve 'hacks' and their summary is as follows:
Cold Water Therapy
The claim is that by dunking yourself into cold water (10-15 degrees celsius), the body responds by increasing dopamine, a feel-good hormone, and reducing inflammation which presumably could be affecting the vagus nerve. HSI's conclusion was that there isn't any significant change in our inflammatory markers when in cold water, but the shock can sometimes increase inflammation as a response. Dopamine is definitely increased, though this is through a sympathetic nervous system response which presumably would have an opposite effect on the vagus nerves parasympathetic nerve fibres. Furthermore, they warn of addiction to the feel-good effects of adrenaline and dopamine, and the potential dangers of a sudden increased heart rate.
Humming, Breathing Exeri=cises and Meditations
Humming exercises, specifically Bhramari Pranayama controlled breathing, may enhance parasympathetic response through heart rate variability. A lower heart rate means a lower respiritory rate and reduced stress response. HSI's findings were that while humming does positively influence the parasympathetic nervous system through the vagus nerve, it is not consistent and is influenced by individual physiological factors. Basically, it does work, but not for everyone.
Breathing exercises and meditation are seen to have similar effects on respiratory and heart rate variability respectively, so follow similar conclusions to humming. With each of these methods there is no cost or risks, so could be worth seeing if it has an impact on you as an individual.
Vagus Nerve Stimulation
Vagus nerve stimulation or VNS uses a device that sends a gentle electrical signal to the vagus nerve to modulate its activity. In recent years it's evolved from an implantable device to a simple wearable device. HSI state that studies show a significant impact on heart rate variability which in turn has positive effects on aspects of the parasympathetic nervous system. It has also been seen to have a significant improvement on cognitive function, sleep disruption, and emotional regulation.
It makes sense that direct stimulation of the vagus nerve via VNS is more consistently effective than the other more subtle methods analysed, it's simply a more invasive treatment. However, I'm always slightly cynical when a therapy that has the potential to generate large profits is head and shoulder above the more natural solutions. I'm not suggesting foul play here, just that when something is marketable, there is often more money thrown at the research of something profitable, as opposed to free, openly available options.
Acupuncture & The Vagus Nerve
Traditional acupuncture theory doesn't specifically refer to particular nerves, but the theory links well to the symptoms of vagus nerve dysfunction. However, I am going to look at some of the more modern techniques that integrate acupuncture and Western biomedicine
Acupuncture for Muscle Tension
If there are postural issues in the neck and shoulders affecting the vagus nerve, then acupuncture and/or massage can be a great tool to reduce muscular tension and correct posture. They does this by breaking down adhesions, overly contracted muscle fibers and increasing blood flow to an area. Specific exercise and stretch advice alongside treatment will also help recovery.
Auricular Acupuncture with VNS
Positive research has come from electro-stimulation at the auricular vagus nerve branch. Studies claiming to impact a variety of symptoms used auricular points and connected electro-stimulation to create vagus nerve stimulation. These points seemed to vary from one study to another and didn't seem to have a strict correlation with Traditional Chinese Medical (TCM) auricular acupuncture points. That said, pictures of ears differ greatly, so they may have had a relationship with the traditional Chinese points, just identified anatomically rather than using the TCM naming system.
Acupuncture & The Parasympathetic Nervous System
Acupuncture has long had the reputation of being calming and relaxing, and modern research has confirmed that it does have a positive effect on the parasympathetic nervous system, aiding our 'rest and digest' state. A systematic review from 2013 looked at 44 publications on the topic and concluded that acupuncture:
"not only activates distinct brain regions in different kinds of diseases caused by imbalance between the sympathetic and parasympathetic activities, but also modulates adaptive neurotransmitter in related brain regions to alleviate autonomic response"
(Qian Qian et al, 2013)
In addition to acupuncture, massage also stimulates the parasympathetic nervous system, regardless of where the massage is carried out on the body. Most types of massage will have this effect however deeper, more uncomfortable forms can produce a response from the sympathetic nervous system. In practice, if I need to use deeper massage techniques I will alternate these methods with more therapeutic techniques to help maintain a balance between the sympathetic and parasympathetic systems.
Acupuncture & Inflammation
As mentioned earlier, inflammation can have a negative effect on vagus nerve function. Acupuncture has been proven to reduce and prevent inflammation from a variety of mechanisms including regulation of cytokines, improved blood flow, and reduced stress and pressure on the nervous system. I've written about this in detail in another blog post so please visit this page if you want to learn more about this topic - https://www.benelliot.co.uk/post/acupuncture-inflammation-exploring-eastern-western-theories-evidence
What have I learned?
Exploring the different methods suggested to 'heal your vagus nerve' has cemented just how diverse the branches and functions of the vagus nerve are. I'm more skeptical of some methods than others and reject the claims that doing 'x' method for 'x' amount of days can irradicate anxiety/IBS/dizziness etc all on its own. However, I can't see any harm in integrating these suggestions into your routines to help manage or improve symptoms as part of a healthy lifestyle. We are all different and need different approaches that suit our individual aetiology and circumstances.
References and Further Reading