#824: Dr. Kevin Tracey — Stimulating The Vagus Nerve to Tame Inflammation, Alleviate Depression, Treat Autoimmune Disorders (e.g., Rheumatoid Arthritis), and Much More
On The Tim Ferriss Show, Dr. Kevin Tracey explores the vagus nerve's role in regulating inflammation and maintaining bodily health. He explains the anatomy of these crucial nerves—which run from the brain to various organs—and describes how Vagus Nerve Stimulation (VNS) can influence the body's inflammatory responses, similar to tapping the brakes on a car.
The discussion covers how VNS technology has evolved into a treatment option for multiple conditions, including arthritis, bowel disease, and depression. Through case studies of patients who have undergone VNS treatment, Tracey illustrates how this approach has helped people reduce inflammation and improve their quality of life without relying on traditional medications. The conversation also delves into the development and FDA approval of the Setpoint Medical Device for treating rheumatoid arthritis.
This is a preview of the Shortform summary of the Aug 26, 2025 episode of the The Tim Ferriss Show
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1-Page Summary
The Anatomy and Function of the Vagus Nerve
Kevin Tracey explains that humans have two vagus nerves, each containing approximately 100,000 fibers. These nerves originate at the brain's base near the ears and travel down through the neck and chest into the abdomen, connecting to various organs along the way. Notably, 80% of these nerve fibers carry information up to the brain, while 20% send signals down to the body's organs.
The vagus nerve plays a crucial role in regulating inflammation and maintaining bodily homeostasis. Tracey notes that a specific subset of vagus fibers controls inflammation cytokines in the spleen, making it particularly relevant for conditions like heart disease, stroke, and cancer.
Mechanism and Applications of Vagus Nerve Stimulation
According to Tracey, Vagus Nerve Stimulation (VNS) works by activating the body's "inflammatory reflex," similar to tapping the brakes on a car. When stimulated, the vagus nerve sends signals that convert white blood cells from a pro-inflammatory state to an anti-inflammatory one, particularly as they pass through the spleen.
Tim Ferriss highlights that VNS shows promise in treating various conditions, including arthritis, bowel disease, and depression. Tracey explains that even brief daily VNS therapy can reduce toxic inflammation levels to safe ranges, potentially offering an alternative to medications with significant side effects.
Case Studies and Outcomes From Vagus Nerve Stimulation
Kelly Owens' case demonstrates VNS's transformative potential. After years of struggling with Crohn's disease and limited mobility, she received a vagus nerve implant during an Amsterdam clinical trial. Within weeks, she regained her ability to run and eventually returned to teaching, no longer needing her cane.
Professor Ulf Anderson found relief from post-surgery depression and inflammation by using a TENS unit on his ear. Combined with antibiotic therapy and famotidine, his treatment led to improved heart rate variability and overall well-being.
Context and Science of Vagus Nerve Stimulation
Dr. Kevin J. Tracey's research at the Feinstein Institute revealed the vagus nerve's role in regulating immunity and inflammation, leading to the development of bioelectronic medicine. After 20 years of development, his team's Setpoint Medical Device received FDA approval for treating rheumatoid arthritis. This milestone validates VNS as a safe therapy, with patients experiencing significant symptom improvement without the risks of immunosuppression typically associated with traditional treatments.
1-Page Summary
Additional Materials
Clarifications
- Inflammation cytokines in the spleen are signaling molecules that regulate the immune response and inflammation levels in the body. The vagus nerve can influence these cytokines in the spleen, helping to modulate the body's inflammatory state. This interaction is crucial for conditions like heart disease, stroke, and cancer, where inflammation plays a significant role in disease progression. The vagus nerve's control over inflammation cytokines in the spleen highlights its role in maintaining immune balance and overall health.
- The "inflammatory reflex" is a neural pathway involving the vagus nerve that helps regulate the body's immune response to injury and infection. It functions by transmitting signals that inhibit the production of inflammatory cytokines, thus reducing harmful inflammation. This reflex mechanism plays a crucial role in maintaining immune balance and preventing excessive tissue damage. Activation of this reflex can help modulate the body's inflammatory response and promote overall health.
- A TENS unit, short for Transcutaneous Electrical Nerve Stimulation, is a device that delivers low-voltage electrical currents to help relieve pain. It works by sending electrical pulses through electrodes placed on the skin, which can help reduce pain signals sent to the brain. TENS units are commonly used for various types of pain management, such as chronic pain, muscle pain, and nerve-related pain. The device is non-invasive and can be used at home under the guidance of a healthcare provider.
- Famotidine is a medication that belongs to a class called histamine H2 receptor antagonists. It is commonly used to reduce stomach acid production and treat conditions like peptic ulcer disease and gastroesophageal reflux disease. Famotidine can be taken orally or through injection and typically starts working within an hour. It is associated with side effects like headache, abdominal pain, and dizziness, with more severe effects being rare but possible.
- Bioelectronic medicine is a field that involves using devices to modulate the body's electrical signals to treat various conditions. It merges principles of biology and electronics to develop innovative therapies that can regulate neural pathways and physiological responses. These devices, like the Vagus Nerve Stimulation (VNS) system, aim to influence the body's bioelectrical signals to restore health and address diseases. Bioelectronic medicine represents a cutting-edge approach that harnesses the body's own electrical systems for therapeutic purposes.
Counterarguments
- While VNS shows promise, it may not be effective for all patients, and individual responses can vary significantly.
- The long-term effects of VNS are still being studied, and there may be unknown risks or side effects associated with chronic use.
- The cost and accessibility of VNS therapy may limit its availability to a broader patient population, potentially creating disparities in healthcare access.
- The mechanism by which VNS affects the inflammatory reflex and other physiological processes may be more complex than currently understood, and further research is needed to fully elucidate these pathways.
- Alternative treatments or complementary therapies may offer similar benefits to VNS without the need for invasive procedures or devices.
- The FDA approval of the Setpoint Medical Device is a significant milestone, but post-market surveillance is crucial to ensure ongoing safety and efficacy.
- The reduction of inflammation via VNS may not address the underlying causes of diseases like arthritis, bowel disease, and depression, which can be multifactorial and complex.
- The case studies mentioned provide anecdotal evidence of VNS's efficacy, but larger, controlled clinical trials are necessary to establish its effectiveness and safety profile.
- Dependence on technological solutions like VNS may overshadow the importance of lifestyle changes and holistic approaches to managing chronic diseases.
- The emphasis on VNS as an alternative to medications with significant side effects may not acknowledge the role that these medications can play in managing symptoms for certain individuals.
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The Anatomy and Function of the Vagus Nerve
The vagus nerve is a critical component of the human body, playing a significant role in the regulation of inflammation and homeostasis.
Vagus Nerve: Two Nerves, Each With 200,000 Fibers
Kevin Tracey states that there are two vagus nerves in the body, with each containing approximately 100,000 fibers. Therefore, combined, the vagus nerves consist of roughly 200,000 individual fibers.
Vagus Nerves Originate In the Brain, Extending Through Neck and Chest To Abdomen, Innervating Organs
Each vagus nerve arises near the level of the ear at the brain's base and travels down the neck alongside the carotid artery. These nerves continue across the chest and into the abdomen, branching out to innervate the various organs within these regions.
80% of Vagus Fibers Send Info to the Brain, 20% To the Body
According to Tracey, within the vagus nerves, about 80% of the fibers are responsible for carrying information from the body's organs up to the brain. Conversely, the remaining 20% carry instructions from the brain back down to the organs.
Vagus Nerve Regulates Body's Inflammation and Homeostasis
Vagus Nerve Fibers Signal Spleen and Organs to Suppress Inflammation
Tracey notes that a subset of the vagus fibers, possibly ranging from 1,000 to 2,000 fibers, is in charge of controlling the production of inflammation cytokines in the spleen. Given that inflammation is an underlying or exacerbating factor in conditions ...
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The Anatomy and Function of the Vagus Nerve
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Actionables
- You can practice deep breathing exercises to potentially stimulate the vagus nerve and promote relaxation. Deep breathing, such as the 4-7-8 technique where you inhale for 4 seconds, hold for 7 seconds, and exhale for 8 seconds, can engage the parasympathetic nervous system, which the vagus nerve is a part of, and may help in reducing stress and inflammation.
- Try incorporating foods rich in probiotics like yogurt, kefir, or sauerkraut into your diet to possibly influence vagus nerve activity through the gut-brain axis. The gut is directly connected to the brain via the vagus nerve, and a healthy gut microbiome may have a positive impact on this connection, potentially affecting overall well-being and inflammation control.
- Engage in regular ...
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Mechanism and Applications of Vagus Nerve Stimulation
Vagus Nerve Stimulation (VNS) is recognized for its ability to reduce inflammation and treat various conditions by activating the body's "inflammatory reflex," as explained by Kevin Tracey and reported by Tim Ferriss.
Vagus Nerve Stimulation Reduces Inflammation By Activating the "Inflammatory Reflex" - A Neural Circuit Dampening the Response
Kevin Tracey compares the signals traveling in the vagus nerve to the brakes on a car. When tapped, these signals activate the inflammatory reflex, which slows down or stops excessive inflammation. He explains that if you stimulate certain fibers in the vagus nerve, it effectively turns off cytokine production, which is part of this reflex. Signals from the vagus nerve travel to the spleen and reduce the turnover of inflammatory cells, switching the white blood cells from a pro-inflammatory state ([restricted term]) to an anti-inflammatory one (M2).
Vagus Nerve Stimulation Converts Spleen Immune Cells to Anti-Inflammatory State
The inflammatory signals travel up the vagus nerve to the brainstem, and signals are sent back down to halt inflammation. The vagus nerve's signals convert white blood cells to M2 macrophages and monocytes, which aid in healing rather than promoting inflammation.
Vagus Nerve Stimulation May Treat Inflammation From Arthritis, Bowel Disease, and Depression
VNS has been recognized for alleviating symptoms by modulating inflammation in various conditions.
Vagus Nerve Stimulation Alleviates Symptoms By Modulating Inflammation
Kevin Tracey discusses using VNS to address the molecular mechanisms of diseases like rheumatoid arthritis, where the traditional approach has been to use treatments like monoclonal antibodies against TNF. Bioelectronic medicine, in contrast, aims to control the nerves that regulate TNF production via devices.
Patients with conditions such as rheumatoid arthritis benefit from VNS, as it switches white blood cells to a healing mode as they pass through the spleen. This action likely promotes healing in affected joints.
In addition to rheumatoid arthritis, Kelly Owens' experience with Crohn's disease illustrates how inflammatory bowel disease can lead to disabling symptoms that affect multiple organ systems.
Tim Ferriss emphasizes that VNS might be an alternat ...
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Mechanism and Applications of Vagus Nerve Stimulation
Additional Materials
Counterarguments
- While VNS has shown promise in reducing inflammation, it may not be effective for all patients, and individual responses can vary significantly.
- The long-term effects of VNS on the immune system are not fully understood, and there may be potential risks associated with altering immune function.
- VNS devices can be expensive and may not be covered by insurance, limiting accessibility for many patients.
- Some studies have reported side effects associated with VNS, such as voice alteration, cough, and paresthesia, which could affect patient compliance and quality of life.
- The mechanism by which VNS affects the inflammatory reflex and cytokine production is complex and not entirely elucidated, which may limit the ability to predict and optimize treatment outcomes.
- Alternative treatments for inflammation, such as dietary changes, supplements, or other non-invasive therapies, may be preferable for some patients and should be considered.
- The evidence supporting VNS for depression is not as robust as for other treatments like cognitive-behavioral therapy or medication, and it should not be presented as a first-line treatment without further research.
- The comparison of VNS to traditional pharmacological treatments may oversimplify the complexities of treating chroni ...
Actionables
- You can practice deep breathing exercises to potentially engage your vagus nerve and promote relaxation. Deep breathing, such as the 4-7-8 technique where you inhale for 4 seconds, hold for 7 seconds, and exhale for 8 seconds, may stimulate the vagus nerve and could help reduce inflammation indirectly.
- Consider incorporating foods rich in probiotics like yogurt, kefir, and fermented vegetables into your diet to support gut health, which may have a positive impact on vagus nerve function. A healthy gut can send positive signals to the brain via the vagus nerve, possibly enhancing its anti-inflammatory effects.
- Enga ...
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Case Studies and Outcomes From Vagus Nerve Stimulation
Vagus nerve stimulation is showing promising outcomes for various health conditions, as evidenced by several personal experiences. It has facilitated remarkable transformations, regaining vital functions and improving quality of life.
Kelly Owens Regained Mobility and Function After Vagus Nerve Stimulation
Vagus Stimulation Restores Kelly's Active Lifestyle
Kelly Owens faced a major health crisis as a teenager with the development of swelling in her knee, which led to a diagnosis of Crohn's disease. She endured difficult teenage years and twenties, marked by hospitalizations and limited mobility, sometimes requiring the use of a wheelchair. Even with various treatments from renowned medical centers, her chronic condition persisted, and she was advised to avoid having children due to medication risks and her health issues.
However, Kelly's life took a turn after participating in an Amsterdam clinical trial where she received an implant, similar to a pacemaker, that was placed under her collarbone and connected to the vagus nerve in her neck. Weeks after the procedure, Kelly could run up stairs to catch a train—something she hadn't done for years and her husband had never witnessed.
The vagus stimulation allowed Kelly to regain her mobility and engage in physical activities she loved but had to give up due to her condition. She documented her experiences, which are publicly available, and after treatment, she was able to return to being a school teacher without the limitations she previously faced. An emotional day with Kevin Tracey included presenting him a cane she no longer required, symbolizing her regained independence and marking the success of vagus nerve stimulation treatment.
Professor Ulf Anderson Using Tens On Ear For Post-Surgery Depression and Inflammation
Ulf's Tens Device and Antibiotic Use Improved Heart Rate Variability and Wellbeing
Professor Ulf Anderson, after undergoing major surgery known as a Whipple procedure, faced post-operative depression due to excessive inflammation in his gastrointestinal tract. Anderson found relief through the application of a TENS unit on his ear to address his post-surgery depr ...
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Case Studies and Outcomes From Vagus Nerve Stimulation
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Counterarguments
- While vagus nerve stimulation shows promise, it may not be effective for all individuals, and results can vary widely.
- Personal experiences, though valuable, are anecdotal and may not be representative of the average patient experience.
- The long-term effects and potential complications of vagus nerve stimulation are not fully understood and require more research.
- The cost and accessibility of vagus nerve stimulation may limit its availability to a broader population.
- There may be a placebo effect at play in some reported outcomes, which needs to be controlled for in rigorous clinical trials.
- The use of a TENS device for conditions like depression and inflammation post-surgery may not be supported by all experts, and more evidence may be needed to validate its efficacy.
- The combination of treatments, such as TENS and antibiotics, may have confounding effects, making it difficult to attribute improvements to vagus nerve stimulation alone.
- The publication of Professor Anderson's treatment in a peer-reviewed journal is a posi ...
Actionables
- You can explore non-invasive vagus nerve stimulation techniques by practicing deep, slow breathing exercises that engage the diaphragm and may stimulate the vagus nerve naturally. This can be done several times a day, especially during moments of stress, to potentially improve your heart rate variability and overall well-being. For example, try inhaling deeply for a count of four, holding for a count of four, exhaling for a count of four, and then holding again for four before repeating the cycle.
- Consider incorporating foods and supplements into your diet that are known to have anti-inflammatory properties, which might support the health of your vagus nerve. Foods rich in omega-3 fatty acids, like salmon or flaxseeds, and supplements such as probiotics or magnesium, could contribute to reducing inflammation and improving vagal tone. Always consult with a healthcare professional before starting any new supplement regimen.
- Engag ...
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Context and Science of Vagus Nerve Stimulation
Dr. Kevin J. Tracey's groundbreaking research on the vagus nerve's role in regulating immunity and inflammation has birthed the emerging field of bioelectronic medicine and resulted in the FDA approval of a novel medical device for rheumatoid arthritis treatment.
Research by Dr. Tracy at Feinstein Institute Found the Vagus Nerve Regulates Immunity and Inflammation
Dr. Kevin J. Tracey, a pioneer in vagus nerve research and the president and CEO of the Feinstein Institute for Medical Research at Northwell Health, discovered that the vagus nerve is involved in the regulation of immunity and inflammation. In his research, he found that stimulating the vagus nerve can turn off the production of cytokines, which regulate inflammation. This concept provided the foundation for bioelectronic medicine, where instead of pharmacological agents, devices are developed to target and control nerve signals for therapeutic interventions.
Discovery of "Inflammatory Reflex" and Vagus Nerve Stimulation Modulating Bioelectronic Medicine Development
Tracey identified the specific reflex control of immunity by the nervous system known as the "inflammatory reflex." This breakthrough elucidated the molecular mechanisms of inflammation and the potential of vagus nerve stimulation (VNS) to treat it. The knowledge led to his concept that inflammation could be treated with devices rather than drugs by directly stimulating the vagus nerve with electrodes, a concept he envisioned 27 years ago.
He theorized that the brain controls inflammation through signals transmitted via the vagus nerve. His decades-long research concluded that the vagus nerve plays a crucial regulatory role in immunity and inflammation, which is instrumental in the development of bioelectronic medicine, marking a significant departure from traditional pharmacological treatments for inflammatory diseases.
Setpoint Medical Device, Developed by Dr. Tracy and Team, Approved by Fda For Rheumatoid Arthritis After 20 Years
After 20 years of development and clinical trials, the Setpoint Medical Device, a product of Dr. Tracy's research, was approved by the FDA for the treatment of rheumatoid arthritis. This compact device targets inflammation specifically without the immunosu ...
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Context and Science of Vagus Nerve Stimulation
Additional Materials
Counterarguments
- While VNS has been approved for treating rheumatoid arthritis, it may not be effective for all patients, and individual responses can vary.
- The long-term effects of VNS, particularly with the Setpoint Medical Device, may still be under investigation, as 20 years of development and trials may not reveal all potential long-term consequences.
- The approval of the Setpoint device, while a milestone, does not necessarily mean it will become a standard treatment, as it may be one of several options, and its adoption depends on various factors including cost, accessibility, and physician preference.
- The concept of bioelectronic medicine, while promising, is still an emerging field, and its efficacy and safety compared to traditional pharmacological treatments need to be established through further research and clinical experience.
- The claim that VNS has no reports of immunosuppression, infection, or cancer risks may be based on current data, but post-market surveillance is necessary to monitor these risks over a larger population and longer time frame.
- The significant symptom improvement reported by patients using the Setpoint device is encouraging, but placebo effects and patient select ...
Actionables
- You can explore non-invasive vagus nerve stimulation techniques such as controlled breathing exercises to potentially reduce stress and inflammation. By practicing deep, slow breathing patterns, you may activate the vagus nerve, which could lead to a decrease in inflammation markers. For example, try inhaling deeply for a count of four, holding for a count of four, exhaling for a count of four, and then holding again for four, repeating this cycle for several minutes daily.
- Consider incorporating anti-inflammatory foods into your diet to support your vagus nerve health. Foods rich in omega-3 fatty acids, antioxidants, and polyphenols can contribute to reducing inflammation in the body. For instance, adding salmon, berries, and leafy greens to your meals could complement the potential benefits of vagus nerve stimulation on inflammation.
- Engage in regular physical activity ...
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