Dr. Kevin Tracey on How the Vagus Nerve Fights Rheumatoid Arthritis | EP 650

In this episode of Passion Struck, John R. Miles sits down with Dr. Kevin Tracey, a pioneer in neuroimmunology, to explore the remarkable healing potential of the vagus nerve. Dr. Tracey explains how this hidden superhighway between the brain and body regulates inflammation and how targeted stimulation is providing life-changing results for patients with rheumatoid arthritis, Crohn’s disease, and other autoimmune conditions. Together, they dive into the science, personal stories, and future implications of using bioelectronic medicine to treat disease without drugs — potentially rewriting the rules of modern healthcare. Visit this link for the full show notes. Go Deeper: The Ignited Life SubstackIf this episode stirred something in you, The Ignited Life is where the transformation continues. Each week, I share behind-the-scenes insights, science-backed tools, and personal reflections to help you turn intention into action. Subscribe🔗 and get the companion resources delivered straight to your inbox. Catch more of Dr. Kevin Tracey: https://feinstein.northwell.edu/institutes-researchers/our-researchers/kevin-j-tracey-mdIf you liked the show, please leave us a review—it only takes a moment and helps us reach more people! Don’t forget to include your Twitter or Instagram handle so we can thank you personally. How to Connect with John:Connect with John on Twitter at @John_RMilesFollow him on Instagram at @John_R_MilesSubscribe to our main YouTube Channel and to our YouTube Clips ChannelFor more insights and resources, visit John’s websiteConnect with John Pre-Order The Mattering Effect: https://matteringeffect.com/Book John to Speak: https://johnrmiles.com/speaking/Keynotes, books, podcast, and resources: https://linktr.ee/John_R_MilesChildren’s Book — You Matter, Luma: https://youmatterluma.com/Substack: https://www.theignitedlife.net/Support the Movement: https://startmattering.com/. Every human deserves to feel seen, valued, and like they matter. Wear it. Live it. Show it. DisclaimerThe Passion Struck podcast is for educational and entertainment purposes only. The views and opinions expressed do not necessarily reflect those of Passion Struck or its affiliates. This podcast is not a...

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00John R. Miles?

  Coming up next on Passion Struck.

• 0:02Speaker 01

  Your body and all its organs is connected, each and every cell almost of your body is connected to a nerve ending. And those nerve endings are receiving information about the status of your cells and your organs all the time. How much glucose is in your liver? How much carbon dioxide is in your lungs? How fast your heart is beating? How much pressure there is in your stomach or your intestines? There is an overwhelming amount of information in your body that is constantly transmitted through sensory nerves, many of them in the vagus nerve, not all, but many of them in the vagus nerve, up into your brain.

• 0:43John R. Miles?

  Welcome to Passion Struck. Hi, I'm your host, John R. Miles, and on the show, we decipher the secrets, tips, and guidance of the world's most inspiring people and turn their wisdom into practical advice for you and those around you. Our mission is to help you unlock the power of intentionality so that you can become the best version of yourself. If you're new to the show, I offer advice and answer listener questions on Fridays. We have long-form interviews the rest of the week with guests ranging from astronauts to authors, CEOs, creators, innovators, scientists, military leaders, visionaries, and athletes. Now, let's go out there and become passion struck.

• 1:26John R. Miles?

  Welcome back, friends, to Passion Struck, episode 650, the show where we explore the science of human potential, the art of intentional living, and the stories that ignite lasting change. Whether you've been with us for years or this is your first time, thank you so much for being here. You're now part of a global movement committed to living with intention, leading with purpose, and unlocking the life you were meant to live. Let me ask you this, what if your body already had the blueprint to heal itself? What if the key to reversing inflammation? A common thread behind most modern diseases wasn't in a pill bottle, but in a signal nerve running from your brain through your body. And what if the next great medical revolution is not about creating new drugs, but about harnessing ancient reflexes your body has had all along?

• 2:11John R. Miles?

  That's exactly what today's guest, Dr. Kevin Tracy, has spent his career uncovering. Dr. Tracy is a neurosurgeon, pioneering scientist, and president and CEO of the Feinstein Institutes for Medical Research. He's also the co-founder of Set Point Medical, the company behind the first FDA-approved vagus nerve implant for rheumatoid arthritis, a breakthrough that could change the way we treat autoimmune disease forever. In this riveting conversation, we explore how the vagus nerve, made up of over 200,000 fibers, acts as the body's superhighway for healing, why stimulating it can regulate inflammation, restore immune balance, and even impact mental health. We discuss the ancient Buddha breathing practice he once discussed with the Dalai Lama

• 2:54John R. Miles?

  and what it reveals about claiming the body's healing reflexes. We go into the science behind the FDA-approved neurostimulation device and what it means for the future of medicine, and why Kevin believes we're only scratching the surface of what neuroimmune modulation can do. If you missed last Friday's solo episode, "The Absorption Gap", I unpacked why so many wellness routines fail, and the hidden science that explains it. Earlier this week, Wolfgang Lindon joined me for a powerful discussion on chronic worry and emotional resilience. Both pair perfectly with today's episode. Want more insights like this? Join our Substack at theignitedlife.net, my free weekly newsletter for behind-the-scenes notes, book insights, and tools to help you live intentionally. And if you found value in today's episode, please consider leaving a review on Apple and Spotify.

• 3:39John R. Miles?

  I'd love to hear your thoughts on today's episode. Now, let's dive into this groundbreaking conversation with Dr. Kevin Tracy. Thank you for choosing Passion Struck and choosing me to be your host and guide on your journey to creating an intentional life. Now, let that journey begin.

• 3:59John R. Miles?

  Absolutely thrilled today to welcome Dr. Kevin Tracy to Passion Struck. Hey Kevin, how are you today?

• 4:04Speaker 01

  Good, John. Thanks for having me on and how are you?

• 4:07John R. Miles?

  I'm doing great and I've been looking so forward to this episode because we're in the middle right now of doing a series on redefining wellness. And I think one aspect of that people are not very aware of is the vagus nerve. And you have just written a great book, came out in May called "The Great Nerve: The New Science of the Vagus Nerve and How to Harness It's Healing Reflexes." What originally drew you to the vagus nerve? Was there a personal or clinical moment that sparked your interest?

• 4:42Speaker 01

  There was. I am a neurosurgeon. I spent years after medical school at the New York Hospital, Cornell Medical Center trained to be a neurosurgeon. But I also spent several years in laboratories at the New York Hospital and at the Rockefeller University next door studying inflammation. And so I had a decade or more of thinking about the underlying molecular causes of inflammation. And as a neurosurgeon, I was interested in finding ways to develop therapies based on what we had learned and were learning then about the molecular mechanisms of inflammation. What my colleagues and I learned in the 1980s

• 5:25Speaker 01

  was that one way of thinking about inflammation, well, first of all, what is inflammation? It's the redness, the heat, the pain, and the swelling that occurs at the sites of injury or infection in the body. So another way of thinking about inflammation, as scientists do, is what are the molecules and the cells that cause the underlying inflammation? The redness, the pain, the heat, and the swelling. And then in the 1980s, my colleagues and I realized that molecules called cytokines, things like TNF and IL-1 made by white blood cells, have a very important role in causing inflammation. And that overproduction of cytokines can actually be the driving cause of inflammation in some conditions.

• 6:11Speaker 01

  And knowing this, it was possible for us to do experiments with molecules called monoclonal antibodies. And these monoclonal antibodies, we showed, were able to stop inflammation in baboons with serious inflammation. That really leads to the question that drove the research for me for the last 30 years, which is if, if your body can make molecules that cause serious inflammation, then how did evolution put in place mechanisms to stop that inflammation or control it? If inflammation has the capacity to do great harm, there, there must be evolutionarily ancient, conserved mechanisms that keep it in balance, that keep it restrained.

• 6:54Speaker 01

  And so I was a neurosurgeon, am a neurosurgeon, thinking about inflammation, and it would be nice to say that I had an original idea or the, a dream about what the solution would be, but actually what happened was surprising, unexpected results in the laboratory. Wow. And here at the Feinstein Institutes and my laboratory here with Sangita, Shavan, and my colleagues, years ago, there was an experiment done, looking at the effect of putting an anti-inflammatory, an experimental molecule into the brains of animals with a stroke. And the idea was if we stop the inflammation around the stroke in the brain, that the stroke would be smaller and there'd be less brain damage.

• 7:38Speaker 01

  And we did that and it worked beautifully. What we didn't expect is that by putting the anti-inflammatory molecule directly into the brain of these mice and rats, that the inflammation in the body of these animals would also be stopped. And this made no sense at all. There was no plausible way to understand why a very small amount of a drug in the brain, not enough to go through the whole body, would stop inflammation through the body. And to make 25 years of work very short, what we had discovered is that the brain was sending signals through the vagus nerve, and the vagus nerve was acting like the brakes

• 8:20Speaker 01

  on your car to stop cytokine production and to stop the onset of inflammation. And that really changed everything. And that simple, unexpected experiment set us on a path of research that's gone on now for 27 years.

• 8:36John R. Miles?

  That is an amazing story and what an inflection point. I know some people are familiar with the vagus nerve because it's becoming more talked about, but there might still be listeners today who haven't heard of it. Yet, but interesting thing is it touches every vital function. How would you explain its role to someone with no medical background?

• 8:59Speaker 01

  Let's begin with where it is and where it goes. So the vagus nerve starts at the bottom of your brain at about the level of your ears and travels down your neck. We call it the vagus nerve, but you actually have two of them, like two thumbs or two kidneys. So one on each side. So these vagus nerves travel down each side of your neck, across your chest and into your abdomen and along the way sends out branches or projections that touch all the organs that you don't think about all day long. Your heart, your lungs, your liver, your pancreas, your intestines.

• 9:36Speaker 01

  Now, we've said there's two vagus nerves. Actually, inside each of those vagus nerves is a bundle of nerve fibers. A hundred thousand individual nerve fibers on each side of your neck. Now, knowing this, it's good to think of it perhaps like a transatlantic cable running between New York and Paris. And it can, and it carries, this cable can carry information going in either direction, from the body to the brain or from the brain back to the body's organs. And that's exactly what it's doing all day long. The signals traveling in your 200,000 vagus nerve fibers are the basis of the reflexes that allow your

• 10:21Speaker 01

  brain and nervous system to control the function of your organs and to keep them in a harmonious balance. So for instance, you take a breath in and the air fills your lungs. That expansion of your lungs causes changes in pressure and changes in carbon dioxide. Those pressure changes and carbon dioxide changes are activating vagus nerve fibers, probably a few hundred of them, that travel up into your brain. And now your brain knows that your lungs expanded and that carbon dioxide levels are changing. The brain and brainstem process that information and reflexively, without you thinking

• 11:05Speaker 01

  about it, respond to adjust things like your heart rate and your blood pressure. And this is the fundamental operating principle of the vagus nerve. It's a conduit for reflexes that keep all your organs functioning in harmony so that you don't have to think about doing it. Imagine you're sitting in the doctor's office and she taps your knee with a rubber hammer and she taps your patellar tendon. That stretches, that's the knee, the knee, the patellar tendon is stretched by the thump of the rubber hammer. That causes signals to go up the sensory nerves into your spinal cord and immediately

• 11:46Speaker 01

  there is a motor signal that returns to your quadriceps femoris muscle, your thigh muscle, and boom, your leg pops up. And you said, who did that? This is happening all day long to control the organs that balance your physiology, to keep everything in what we call homeostasis, which is health. Homeostasis and health depend on healthy reflexes in your vagus nerve.

• 12:10John R. Miles?

  So I wanted to take this a little bit different direction. I think that's a great baseline. I had a conversation a few years ago with Dacher Keltner, who's a professor at the University of Berkeley, and our conversation was all around his book that was about awe. But in this discussion, he was telling me that when you experience awe, it can connect to the vagus nerve and it is what influences your emotions. I didn't really understand the science behind that, and I was hoping you might be able to explain it to some extent.

• 12:46Speaker 01

  The simple answer is, nobody completely understands it, John. When you're talking about 200,000 individual nerve fibers, each with an evolutionary history that dates back millions or hundreds of millions of years, each has a specific root, a specific origin, a specific destination or insertion, and each has a specific function. When someone tells me they want to stimulate their vagus nerve, I like to joke, okay, there's 200,000 of them. Which one do you want to stimulate? And we don't know, we don't know enough to give a simple answer to your questions. Let me give you, let me give you an example about some, a few things we do know.

• 13:31Speaker 01

  Steve Lieberliss, a brilliant researcher at Harvard Medical School in Boston, did a beautiful study some years ago, and he's followed it up with others, but I'll just talk about one. And he asked a question, in mice, which have about 5,000 vagus nerve fibers, in mice, how many vagus nerve fibers control breathing? Now, breathing's pretty important, the vagus nerve's pretty important. I think most people at first blush would think it would be an enormous number controlling breathing. It turns out, it's about 100 fibers control, and within those 100 fibers, a few dozen might control inhalation or the maximal inspiration volume.

• 14:13Speaker 01

  Another few hundred might, or a few dozen fibers might control the duration of breath holding between inspiration and expiration. And down the list, a few dozen more control expiration. Think about that, it's amazing. If something as important as breathing, which does require, for healthy, normal breathing, does require a healthy, normal vagus nerve functions. But if we've accounted for 100 or 200 fibers in breathing, well, what are the other 4,800 fibers doing? Now, if you go to heart rate control, which is another area with hundreds of millions, if not billions of web impressions on social media,

• 14:57Speaker 01

  there's just, again, a similarly small number of fibers project in the vagus nerve from the brainstem to two different sites in the heart. And when the vagus nerve signals traveling into the heart increase, heart rate tends to slow. And so you can study that as an isolated phenomenon. So you can, in a physiology lab, either in animals, like, there's a beautiful, let me do one more example. Out of New Zealand, you can study sheep, as was done recently in New Zealand a couple of years ago. And you can attach all kinds of sophisticated monitors and electrodes to a sheep as it runs on a treadmill. And if you can imagine, it sounds like a Far Side cartoon, right? Sheep running on a treadmill in a lab.

• 15:43Speaker 01

  You can almost imagine them smoking a cigarette afterwards or something in the Farzai cartoon. But the question the investigators asked and answered was really simple and elegant. So we all know that the vagus nerve is the rest and digest part of the nervous system, and it opposes the fight or flight or sympathetic part of the nervous system. So the vagus nerve is parasympathetic and the fight or flight is sympathetic. Now, we all know when you exercise, you increase your sympathetic nervous system. You get pumped up, your heart rate increases, your blood pressure increases. That's all true. What they proved by looking very carefully at the signals traveling in the vagus nerve

• 16:25Speaker 01

  and in the blood flow through the coronary arteries and in cardiac output measurements that they did in these sheep is that when the sympathetic nervous system was upregulated during exercise, it didn't turn off the vagus nerve signals. It turned, the vagus nerve signals were also turned on. They were both on. And when, in fact, both were important because when they cut off the vagus nerve signals in these sheep, the coronary artery blood flow decreased and the workload or the efficiency of cardiac and muscle function decreased. So in order to have optimal performance during exercise, it was actually a synergistic effect

• 17:06Speaker 01

  or an additive effect between the sympathetic and parasympathetic systems working together. So just in those three examples, right? Heart rate, breathing, and exercise, you see how complicated your question is. Eighty, eighty percent of the 200,000 fibers in human vagus nerves are sensory. What happens when you take a big breath, as I said in the first example, which is classically used as a way to start a relaxation therapy, for instance, is you see that during that inhale... You actually speed up your heart rate a little bit. And that has to do in part with the fact that you've changed the volume and pressure in your lungs

• 17:50Speaker 01

  by inhaling because you've lowered your diaphragm. So you've made a bigger volume so the pressure drops. That causes your heart to twist a little bit on its axis. You can see that on EKG and it causes your pulse to speed up. If you feel your pulse carefully and you take a three-second inhale, you can actually feel your heart speed up a little bit. And then when you exhale slowly for seven seconds through, say, purse lips, you can actually feel your heart slow down again. So what you're seeing is a real-time effect of the incoming signals in the vagus nerve to the brain, which is coordinating the outgoing signals through the sympathetic nervous system and the vagus nerve to increase and decrease your heart rate.

• 18:34Speaker 01

  And this is all done so that your breathing is coordinated with your heart rate changes so that your blood is optimally oxygenated. Now, is that stimulating your vagus nerve or is it a lot more complicated than that? That's the semi-medium-long-form answer to your question. And we're just getting started, really.

• 18:59John R. Miles?

  I was gonna ask this question later on, but since you were just talking about sheep and exercise, I'll jump to I think it's chapter 10 in your book where you write that things like cold exposure, breath work, meditation, you were just talking about breath work, stimulate vagal tone. Can you walk us through why these practices are so effective?

• 19:20Speaker 01

  You said they're effective. I didn't.

• 19:25Speaker 01

  What I say in the book is that whether it's breath work or exercise, various types of cognitive behavioral therapy and meditation, there's a grain of truth in all of those things in some people, done in some ways to culminate in a lower resting heart rate. If you look at a group of subjects. And one subject has a lower heart rate, resting heart rate than another. And, and other health factors and medications are all equivalent. Then that's one sort of quick and easy way to estimate that the

• 20:08Speaker 01

  activity of the vagus nerve fibers to the heart in the patients or the subjects with the lower heart rates is higher than the vagus nerve activity in the group of subjects who have a higher heart rate. So, why is that? Well, that's because we can be pretty certain that the fibers to the heart, vagus nerve fibers to the heart that tend to slow heart rate seem to have more activity, as I said, all of the things being equal, if the heart rate's slower in one group than another. Okay, that we know. We can't connect all the dots without looking at, as I said, animals modern, with very sophisticated technology and elaboratory.

• 20:51Speaker 01

  We can't connect all those dots between input vagus nerve sensory fibers and output. So in the case of deep breathing or meditation associated with breathing in on three and out on seven. By changing your breathing, you are changing the vagus nerve signals associated with inspiration and expiration, which changes the vagus nerve signals going to the heart. And that doesn't mean necessarily that when you breathe in and activate those vagus nerve fibers associated with the lungs and heart, that you're also associating all the other vagus nerve fibers, the other,

• 21:34Speaker 01

  the other fibers of the 200,000 fibers to your stomach, for instance, or your intestines or your liver. There's no evidence that because you activate one vagus nerve fiber, you're activating all of them. And so the questions are interesting because there are clinical studies of correlation between conditions or behaviors that lower heart rate and outcomes or quality of life measures that seem to improve. So as a across the board recommendation, the things that tend to lower the pop the heart rate of a population are things that are good for your well being and mental health.

• 22:19Speaker 01

  Regular aerobic exercise, eating a balanced diet, meditated practices or cognitive behavioral practices or avoiding stress and anxiety, getting enough sleep, having a having hobbies and being well integrated into cognitive activities and social activities. All of these things you can find evidence in fairly good studies that all of those practices are associated with decreasing heart rate. Therefore, you could say increasing vagal tone. There are also studies looking at a more now popular lately measure of

• 23:03Speaker 01

  what's called vagal tone, looking at heart rate variability, which is a little more complicated. But suffice it to say, these correlations do not prove causality. And that's really the rub. That's really the answer to your question. There's a lot of correlative data of meditated practices, lower heart rate, feeling better. Does that mean that you feel better because you stimulated your vagus nerve? Maybe, but it's not proved.

• 23:35John R. Miles?

  So begs the question with 200,000 fibers that are constantly transmitting data, how in the heck does the body prioritize what gets acted on first? Is it like competing radio signals?

• 23:50Speaker 01

  That is why I wrote the book was to try to break down that very question into understandable sound bites. So the first thing you have to get your head around to understand the answer is that your body and all its organs. Is connected, each and every cell, almost, of your body is connected to a nerve ending. And those nerve endings are receiving information about the status of your cells and your organs all the time. How much glucose is in your liver? How much carbon dioxide is in your lungs? How fast your heart is beating? How much pressure there is in your stomach or your intestines? There is an overwhelming amount of information in your body

• 24:34Speaker 01

  that is constantly transmitted through sensory nerves, many of them in the vagus nerve, not all, but many of them in the vagus nerve, up into your brain. Now, if you were the little person standing inside your brain, looking down at the information coming up the vagus nerve, you would be seeing a second-to-second report of the status of the health and function and outputs of all your organs, which makes sense, right? It begins with the input. Now, the inputs are relayed through a number of centers in the brainstem and called nuclei, which function like the router in your house, where the information comes in from the internet

• 25:19Speaker 01

  and the router distributes it to your iPhone or to your kid's laptop or to whatever, all through the house. It parses all the information. In the case of your brainstem, all the information comes in from the body and the brain routes it through different networks. Now, each network is capable of sending a response back to the body. Now, just like the knee-jerk reflex we talked about before, reflexes tend to act in opposition to the input. So the tendon stretches, so your leg bounces up because your thigh muscle contracts.

• 25:56Speaker 01

  In the case of, say, too much pressure in your stomach, the incoming signal going up the vagus nerve would say the pressure in the stomach is high. The descending signal from the brain would say, we better relieve that pressure either by relaxing the stomach or contracting it to propel the food down to the next station. And you do that for every single input. Thousands and thousands of input, each one very specific. Each one induces a highly specific reply, reflex output. So you almost have to think about it to the scientific, the correct answer. There's philosophical and psychological answers you could talk about all day long.

• 26:40Speaker 01

  But the scientific, physiological answer has to be answered one fiber at a time, in and out.

• 26:47John R. Miles?

  I just wanted to go through a hypothetical here. Let's say I was a former military person, served in combat. And let's say you get injured on the battlefield and your vagus nerve is severed. What happens to an individual? Can it be repaired? I understand if it's severed on both sides, it causes instant death. But how does that disrupt your functions?

• 27:13Speaker 01

  The important point you just made should bear a little explanation for those who haven't read the book. But the vagus nerve is the only nerve in the body that if you cut it on both sides, you die, which is interesting. If you cut the spinal cord high enough up, you die. But it has a nerve, the cranial nerve arising from the brain. So it has these very important functions. You can survive a vagus nerve injury being damaged on one side. And whether it can be repaired or not really depends on the nature of the injury and how quickly the neurosurgeon could get in there to reconnect fibers in the hopes that some would grow back. But a more common example, rather than a vagus nerve injury, actually, we saw during COVID. So, near the end of the COVID pandemic, there were a series of studies that came

• 27:58Speaker 01

  out. It started in Spain, from researchers looking at autopsies, people who had died of severe COVID, of COVID-19. And when they looked at the vagus nerve of these cadavers, they found that the vagus nerve, many of these deceased patients, had the SARS virus, the COVID virus, in their vagus nerves. And there was evidence that the vagus nerves were damaged, and there was evidence of inflammation in and around the vagus nerve. Now, we know that vagus nerve damage, or dysfunction, will actually, you could think of it as damaging the brakes in your car, the brakes that normally suppress inflammation.

• 28:43Speaker 01

  So, we know if you cut the vagus nerves in animals and subject them to any inflammation stress, that the inflammation is much, much worse, much more lethal, much more dangerous, if the vagus nerve is not working. And we know if you stimulate the vagus nerve in these inflammation conditions, that you can stop inflammation. So, knowing that the COVID victims had damage to their vagus nerve has opened a whole new field of research, asking, if the vagus nerve can slow down inflammation, and COVID, or SARS, can damage the brakes, damage the vagus nerve, is that why some people have long COVID? Do they have underlying

• 29:27Speaker 01

  vagus nerve damage? And so, some studies have continued in addressing this question, and there is now evidence with MRI scans and high sensitivity ultrasound studies that have been published. And in fact, Some patients, some COVID survivors who have long COVID do have evidence in their vagus nerve damage. So the work continues because, again, it's a correlation, it's very interesting, but it doesn't prove causality. But it's an important question you're asking. When you go into fields like rheumatoid arthritis, inflammatory bowel disease, and other conditions of autoimmunity or autoimmune illnesses, and you ask, what is the evidence for vagus nerve

• 30:11Speaker 01

  dysfunction in those patients? It turns out there's a lot of evidence. So in rheumatoid arthritis patients, and several studies have now demonstrated this, including one that my colleague Sangit Shivana and I here at the Feinstein Institutes in New York, one that we published, we measured heart rate variability, which we set as a surrogate marker for vagus nerve activity to the heart. And what we found was that patients with autoimmune conditions have poorer vagal tone, they had less heart rate variability, more heart rate variability associated with more vagal tone than subjects who are healthy

• 30:53Speaker 01

  and did not have autoimmune conditions. Very interesting. Again, correlation, it doesn't prove cause and effect, but there's a tremendous interest in this. Can we use heart rate variability as a surrogate marker for the fibers in the vagus nerve that stop inflammation? The question is maybe. And if so, does that answer your question that how much evidence is there for vagus nerve damage in contributing to subsequent conditions? There's growing evidence.

• 31:24John R. Miles?

  Well, since you just brought up rheumatoid arthritis, I'm going to go here because just days ago, the FDA approved the SetPoint system, which is an implantable device you co-developed as a treatment of rheumatoid arthritis. That is such a landmark achievement, something you've been working on for decades. What does this moment mean for you personally into the future of medicine?

• 31:52Speaker 01

  There's huge implications for this. To be clear, Setpoint Medical is a company that I co-founded in 2007, based on the science that came out of my laboratory at the Feinstein Institute. I did not develop the device. The company developed the device over many years. The company was founded in order to develop new devices that would target the vagus nerve in order to reduce inflammation in patients with rheumatoid arthritis and other autoimmune conditions. And the number of people that worked on that project and brought this idea to life are too many to name. Over the years, there have been many dozens, if not hundreds, of people at Setpoint who conceived of how to design the device, build the device,

• 32:37Speaker 01

  launch the clinical trials, design the clinical trials, fund the clinical trials, and then ultimately to produce a 24,000-page document for the FDA to review, which culminated, just last week, as you point out, in the FDA approval for the Setpoint Medical device as an immunoregulator to treat rheumatoid arthritis patients. So hats off to Murthy, the CEO, and his team at Setpoint for doing this and leading the charge. What it means is a tremendous new therapeutic option for one and a half million patients in the United States who should be eligible as possible patients

• 33:18Speaker 01

  because they have rheumatoid arthritis, which is not responding or getting better from the currently available drugs. The currently available drugs are drugs called biologics and JAKs or JAK inhibitors. These drugs work terrifically well in some patients, and there's a lot of good that can be said about them. But for about half the patients that take them, they don't work well or don't work at all. And more importantly, even in the patients that are deriving benefit from the drugs, the drugs have significant side effects. These drugs all cause immunosuppression, which means that

• 34:01Speaker 01

  The immune system is suppressed to the point by these drugs that patients are at risk for serious complications of secondary infections, tuberculosis, sepsis, even some forms of cancer. So patients in general that I've talked to would prefer a therapy with less side effects, and that's exactly what the SetPoint device offers. The SetPoint device is about the size of a multivitamin. It's called an immunoregulator. It sits on the vagus nerve in the neck at about the level of your Adam's apple. And the safety profile in the clinical trial, which led to the FDA approval, is absolutely terrific. All the detailed information about safety and patient eligibility and effectiveness

• 34:43Speaker 01

  are on the SetPoint medical website, and you can steer your listeners to that for the detailed information. And how it works and the science behind it that came out of my laboratory, that's detailed in my book, The Great Nerve.

• 34:56John R. Miles?

  I wanted to go there next. How does it actually stimulate the vagus nerve and reduce inflammation? Because that, to me, was remarkable, because as you were just saying, the current drugs are only working at most on about 50% of the rheumatoid population, if I have that figure correct.

• 35:15Speaker 01

  You do have the figure correct. It's somewhere between 40 and 50% of patients today benefit from those rheumatoid arthritis drugs. And these are drugs that have immunosuppressing side effects and sometimes cost between $50,000 and $100,000 a year. So not everybody can even afford these drugs. So the point is really that other options are going to be welcomed. The way it works is based, as we talked about in the beginning, on 27 years of work in my laboratory, and now also in dozens of laboratories around the world by hundreds of other people. The science of this is actually very well mapped out. I actually like to say when I'm lecturing about this, that in many ways, we understand the

• 35:59Speaker 01

  science of how the vagus nerve stops inflammation better than we understand how some of the biologics actually work. The way it works is that signals arise in the brain, a brainstem, which is where the vagus nerve begins, as I said, at about the level of your ears. These signals travel down fibers.

• 36:18Speaker 01

  And in the human vagus nerve, we estimate it's about 1,000 fibers are sufficient to do this. It could be more, it could be less. In mice, we estimate it's a few hundred. These 1,000 fibers travel down your neck, down your chest, into your abdomen. There, they terminate, they end on a bundle of neurons called a ganglion, which in turn sends additional nerve fibers into your spleen. In the spleen, the electrical information is converted to chemical information. That means that the signals that we can, in mice anyways, we can actually begin the signaling process with very sophisticated electrodes and other methods directly in the brain of the mouse.

• 37:03Speaker 01

  We can follow the signals all the way into the spleen, where the electrical signals are converted into chemical signals called norepinephrine and acetylcholine. The acetylcholine actually comes from white blood cells called lymphocytes or T cells that are activated by the norepinephrine that's being released by the nerve endings in the spleen. Now, the acetylcholine being made by the T cells is the signal to the other white blood cells called monocytes and macrophages to stop making cytokines. It also does something else. It causes these monocytes to change their behavior. So, one behavior of a monocyte, we call M1,

• 37:47Speaker 01

  and that's the angry attacking white blood cell. And that's the white blood cell that goes to your joints if you have rheumatoid arthritis and causes the redness and the pain and the swelling. But in the spleen, the signal from acetylcholine made by the lymphocytes actually causes those monocytes to switch and become what we call M2, or tissue repairing monocytes. If you have tissue repairing monocytes leaving your spleen because your vagus nerve was stimulated, those tissue repairing monocytes can increase the healing in the joints rather than increase the damage. Now, all of this is based mostly on work in mice and rats

• 38:30Speaker 01

  and other animals in the lab because it's very hard to do these kinds of studies in humans. But surrogate measures of everything I said has also been founded in human clinical studies. And that's why so many people are optimistic. When you look at the results... Of the first clinical trials, and when you look at the results from the most recent clinical trial of 242 patients, 75% of the patients after one year of vagus nerve therapy with the immunoregulator from Setpoint, 75% of those patients were using the immunoregulator as their mainstay of therapy. They were no longer using biologics or JAKs. And that's

• 39:12Speaker 01

  huge because that means that you're not only gaining clinical benefit for the pain and swelling in the joints, but you're also avoiding the risks of the black box warnings on those immunosuppressive drugs.

• 39:26John R. Miles?

  Thank you so much for going into that. And I want to read something from your book. You write that today, we know that there are billions of synapses in the nervous system that are activated when the vagus nerve is stimulated, which you were just talking about. Thus, by accessing the vagus nerve with an electrode in your neck, we're beginning to learn how to modulate the physiological harmony of your body and brain. That sounds like an enormous discovery that not only is going to help rheumatoid arthritis, but this could go on to help so many bodily functions. Where do you see the potential of where this could go beyond just this apparatus?

• 40:10Speaker 01

  The potential is great because we can apply the methods that we use to mapping what we call the inflammatory reflex, which are the signals I just described. The signals when you have inflammation in your body, the vagus nerve detects the inflammation. That's the sensory input. That's the rubber hammer tapping your knee. That's the input signal. The brain responds with the other signals I just described that travel from the brain to your spleen to stop the inflammation, counteract it. That's the output. So by approaching questions of body, brain function, and the relationship between conditions that cause

• 40:53Speaker 01

  diseases in the brain or diseases in the body that influence the other and vice versa, by approaching these seemingly extraordinarily complex questions, one nerve fiber at a time, you can begin to Develop enough knowledge, we call that molecular mechanisms or neurophysiological mechanisms to now intervene with therapies. So, again, you have 100,000 vagus nerve fibers on each side. A very relatively small number appear to be sufficient to stop inflammation in patients with rheumatoid arthritis, or at least to make it significantly better. Now imagine, we're doing that today with the devices we use by putting in a very small amount of current.

• 41:37Speaker 01

  The current only flows for one minute a day at 400 microamps. That's nothing.

• 41:45John R. Miles?

  You can sleep through that.

• 41:47Speaker 01

  Some patients that I've met from the clinical trial are sleeping through it. The device is programmed in some of these patients to fire at 4:30 in the morning, and some patients literally sleep through the stimulation. The other thing it tells you, because it's only 400 microamps, is we're not stimulating all 100,000 fibers. We're stimulating a small subset of fibers that is sufficient to stop the inflammation. Now, as knowledge of the vagus nerve anatomy and the vagus nerve function continues to grow, will it be possible someday to identify the fibers that are traveling up into the brain to activate the pathways, for instance, associated with increased attention?

• 42:31Speaker 01

  Can we follow the fibers that go into the locus ceruleus, which then are relayed up into the basal forebrain cholinergic system or to the dopaminergic systems of the brain? Can we identify the individual fibers that participate in reflexes that might explain why so many patients with vagus nerve stimulators say that it improved their quality of life because it made them feel happier? This was the basis, it was clinical observations, decades ago, actually, in the 1990s, of patients who had vagus nerve stimulators implanted to treat epilepsy.

• 43:11Speaker 01

  And many of these patients reported to their physicians, "I feel happier, I feel better. The device is not helping my epilepsy for one reason or another, but I want to leave it in because my outlook on life has improved." That actually led to clinical trials.

• 43:29Speaker 01

  Using vagus nerve stimulation therapy to treat patients with severe depression that is not responding to advanced talk therapy or medical therapy. Well, what happened? Well, 50% of the time, give or take, patients get significantly better with the vagus nerve stimulation. Well, what about the other 50%? Why doesn't it help them? It's back to your question. We don't understand the mechanism. If we knew in advance which patients would benefit from vagus nerve stimulation therapy, we could screen them and not implant the 50% of the patients in which it doesn't benefit.

• 44:09Speaker 01

  We can't answer that question because we're not sure of the underlying reflex circuits that are dictating the beneficial response or the absence of a response. So your question is spot on because the basic principles of mapping reflex circuits in the vagus nerve can serve as a guidepost for developing new therapies for other conditions that may or may not be mediated by other vagus nerve fibers.

• 44:37John R. Miles?

  Kevin, I wanted to go back to my example of being in the military. And I know that one of the things that has been a result of people being in the 20 years of war that the United States was in, in Afghanistan and Iraq, is a lot of people were exposed to bomb blasts, which caused, almost like if you were in a football game, lots of trauma that keeps on repeatedly happening. And it's caused a lot of people to feel the symptoms of having traumatic brain injuries because of this constant trigger event. I guess it's the same thing that leads football players to getting CTE.

• 45:19John R. Miles?

  And I understand that one of the causes for dementia is, might also be related to this, where for whatever reason the amyloid plaques aren't getting flushed through the system. Where I'm going with all of this is, is there any correlation to all these things and potentially the vagus nerve being at the center of what's causing these ailments?

• 45:44Speaker 01

  I don't like to put it at the center because each of those are so different conditions. So post-traumatic stress syndrome is extremely different than CTE, the football, repeated concussion injury syndrome, and that's very different than Alzheimer's. Where there's a convergence in the story is all three of those conditions have implicated a role for inflammation in contributing to those conditions or making them worse. And so you can ask the question, it's fair to ask the question.

• 46:17John R. Miles?

  Let me reframe it. I guess where I was going to this is inflammation on the brain, which seems to be the same thing across all of them. And what's interesting to me is oftentimes, PTSD has overlapping symptoms that a TBI or repeated TBIs that would bring about, or CTE would bring about, which mirrors some of the symptoms that you would experience with dementia or Alzheimer's.

• 46:44Speaker 01

  John, you are asking the question like a savvy researcher and there's openings in my lab. If you have time, we're always looking for good people. That is the right question. And again, to go to break it down to first principles, individual nerve fibers, individual molecular targets, individual molecular mechanisms. You really need to connect the dots by asking those kinds of questions. So let's start with the question of post-traumatic stress and we'll start top down. So in PTSD, there's good evidence in many of those patients that some percentage of them, I don't know if it's half, I think it's about half, can gain significant benefit improvement from various cognitive behavioral therapies.

• 47:29Speaker 01

  And some can even be guided by, say, an app. And there's some exciting new advances in, and actually some consensus arising on the best cognitive behavioral or talk therapy approaches that have helped a lot of people with PTSD. So that's good. What's also known, and this goes back many years, again, to patients who had vagus nerve simulators originally implanted for epilepsy. That if you have, if you give cognitive tests and attention testing to volunteers before and after you turn on the vagus nerve stimulators in their neck, which is presumably driving signals up into the router in your brain that we talked about,

• 48:12Speaker 01

  that their attention improves and their, and their ability to learn and to, and remember actually improves as well. So that's amazing, right? The driving vagus nerve signals is good for your cognition and attention. So knowing that and knowing also that those behaviors are good for neuroplasticity and knowing that neuroplasticity or brain remodeling is a really important part of the clinical response to say, talk therapy or cognitive behavioral therapy. Investigators recently put all those things together. And they, I don't know if you saw the news, maybe that's why you're asking me, but there's a recent report out within the last month or so

• 48:55Speaker 01

  of a clinical trial implanting vagus nerve stimulators. And this, and these stimulators were timed not, to not work all day long, but to only deliver a pulse, a simulation of the vagus nerve in the neck, driving signals up into the brain timed with the function of the app. And what they found in these PTSD patients is the effectiveness of the app went from 50%, I think to 100%.

• 49:22John R. Miles?

  Oh my gosh, I didn't realize it was that high.

• 49:25Speaker 01

  It's unbelievable. You can Google it and double check all the facts, but there was a tremendous clinical response. This study was published in a very high impact peer reviewed journal and it was picked up by the press around the world because it speaks to what you said. Can we link vagus nerve therapies to these complex, difficult to treat brain therapies? Now that's the most advanced of the three. There are theories and hypotheses being pursued for CTE and Alzheimer's, and there's hope, but the first clinical trial results appear to be in for PTSD. And what remains to be seen, of course, is that trial will have to be replicated.

• 50:09Speaker 01

  And with every new discovery, whether it's in the lab or in the clinic, there's 100 new questions. So this will have to all be pursued, but it's a really interesting time for the answer to that question.

• 50:20John R. Miles?

  And I want to ask one follow on to this. The other thing, I haven't done any episodes on this recently, but in the past, I've done a few on this. One of the most fascinating was with Dr. David Yaden, who's at Johns Hopkins, is he's been trying to study psilocybin and its effects on these same types of conditions. And the thing he told me was right now, talk therapy, its efficacy is somewhere around 30%, where psilocybin and MDMA are showing as high as 65 to 70% efficacy. And it goes back to the question I asked earlier about

• 51:02John R. Miles?

  breath work, meditation. Could some of these mind altering drugs also be having an impact on the vagus nerve?

• 51:12Speaker 01

  Yes, they absolutely could. When you look at the clinical effects of these various drugs, some of them slow heart rate. So again, using our simplest definition of vagus nerve stimulation, if you consume a drug and your heart rate slows, and presumably, we're talking about drugs that affect primarily the brain, not a beta blocker or something that slows your heart through sympathetic nervous system. But if you take psilocybin, one of the other psychoactive drugs, and your heart rate slows, then you have quote unquote stimulated your vagus nerve. Have you stimulated the vagus nerve fibers to your pancreas? No one knows. Have you stimulated the vagus nerve fibers to your immune system? No one knows. So the

• 51:57Speaker 01

  problem isn't with saying vagus nerve stimulation. The problem is with assuming that the vagus nerve fibers all have to fire together. All of us can walk and chew gum at the same time. Some people can play the piano and carry on a conversation at the same time. That's because each of those neurons in your body, in your brain, and in your spinal cord, and in your autonomic nervous system, all of these neurons, as I said before, they have a specific origin, a specific destination, and a specific function. And they can operate separately.

• 52:32Speaker 01

  And so treating the vagus nerve as a solid copper wire, which is what frankly, much of the self-help advice in those billions of web impressions is based on the idea, "Well, you can hum and you stimulate your vagus nerve, and then your life is better because you've stimulated your vagus nerve." Well, maybe, right? So you have, again, a few hundred or a thousand fibers of your vagus nerve in your neck, branch off and go to your voice box, go to your larynx. And they are very important signals that control your vocal cords. So when you hum, those fibers in your vagus nerve are very busy controlling your vocal cords. Does that mean that the fibers controlling your heart are activated?

• 53:17Speaker 01

  No. Does it mean the fibers to your pancreas and stomach are activated? No. And the answer is, maybe they are, but we don't know that. The fact that you hum and feel better may be because you've slowed your breathing. And when you slow your breathing, you change your carbon dioxide levels. And when you change your carbon dioxide levels, you get different feedback to your brain. Every one of these quote-unquote "simple things" is doing thousands of other things to your body that could also be influencing your state of mind and how you feel. So yes, humming stimulates the branches of your vagus nerve to your voice box. But whether it... I can't stress this enough. The differential activities of the individual fibers

• 54:01Speaker 01

  is really the opportunity to do better for our future knowledge and for our future patients. There's no harm in talking about the vagus nerve as a solid copper wire. There wouldn't necessarily be much harm in that, except that a lot of people are trying to profiteer from it and sell things that will do this, that, or the other thing on your neck or somewhere else to stimulate your vagus nerve when there's no evidence that actually is stimulating your vagus nerve. And so the profit margin fits into this. And as a scientist and as an inventor, I also do worry about how some of this outright false information actually dilutes the importance of the important new science

• 54:46Speaker 01

  that comes out and has supported things like this FDA approval.

• 54:50John R. Miles?

  Kevin, one of the reasons I am so excited about having you on the podcast, I've been looking forward to this interview so much, is the bigger picture. So, we've talked a lot about today, inflammation, and inflammation is the common thread across most modern diseases. So, if you think about this from a larger perspective, that inflammation is at the root cause of why so many millions of people around the world are suffering, and the research is starting to point to the vagus nerve as helping to turn that tide, it just speaks to how large the work

• 55:30John R. Miles?

  that you've been doing over the past two decades could potentially be to influencing so many people's lives in a better way. My question from that is, do you believe modern medicine is shifting fast enough to embrace this kind of integrative systems level thinking to help

• 55:50Speaker 01

  people? I don't know, John. I hope that the adoption of this therapy in first, obviously rheumatoid arthritis, because that's what the FDA approval is for, will drive an explosion of interest in some of the other conditions. You're specifically referring to heart disease and stroke, cancer, diabetes, metabolic syndrome, obesity, all of it. These conditions account for the mortality of two-thirds of the people who die on planet Earth every year. Forty of the 60 million people who die on planet Earth, according to the WHO, die of those and a couple of other conditions, and they all are either caused by inflammation or made worse by inflammation. So, the question

• 56:33Speaker 01

  you ask is the big question, and my hope is that the ongoing research that's already occurring around the world... Thinking about treating inflammation using vagus nerve stimulation and other frankly, other possible nerves that control other types of inflammation, that this work will accelerate. How quickly it gets adopted into medical practice? Well, that's one of the main reasons that I wrote my book, is to provide a platform for people to begin to talk about it, to share the same language and background. There's a chapter in there called FAQs for patients to ask their doctors. Those questions are written for the patients. The answers are written for the patients and the doctors.

• 57:18Speaker 01

  Most doctors haven't thought about the vagus nerve since medical school. And you asked specifically about adoption. A couple of things have to happen. There have to be a lot more clinical trials. The rheumatoid arthritis idea is launched. I think that will gain traction quickly because patients are looking for it. And I know this because SetPoint Medical launched its clinical trial for 242 patients, and they had almost 30,000 patients go on the portal and try and enroll in the trial. So there's an enormous demand and interest in that population. SetPoint is launching clinical trials very soon in multiple sclerosis. The preclinical data for that are fascinating. We could talk about it. I'm aware of other clinical trials for inflammatory bowel disease,

• 58:03Speaker 01

  Crohn's disease, ulcerative colitis. I would not be surprised to see clinical trials for psoriatic arthritis. And I'm aware of preclinical studies, laboratory studies, and small clinical trials looking at diabetes and looking at inflammation associated with other conditions affecting other organs. So this is an incredibly exciting time. I think if you're a patient or have a family member or friend suffering from one of these conditions, things are not going fast enough. And why is that? Well, you really, if you think about it, you don't really want your doctor chasing every shiny object. Medicine has a conservative side to it with good reason.

• 58:47Speaker 01

  Things take time to work out the molecular mechanisms and to understand how they really work. Things take time to build new devices that are proven safe and reliable. Things take time to change business practices and workflows and payer behavior and regulatory behavior. There's no bad people doing this. It's just that you want to do it right. You want to know what you're doing and that takes time. Putting all that aside, I think we've launched with this FDA approval and all the science behind it and all the engineering that Setpoint did behind it. I think we've launched a new era and I think it might go faster than people are realizing.

• 59:29John R. Miles?

  Kevin, I have one last thing I wanted to talk to you about. This week, prior to me putting your episode out, I did a solo episode on something that I'm calling the absorption gap. And let me explain this to you. I host an alternative health podcast, so I've had lots of people on this show talking about cold plunges, to functional medicine, to clean eating, to better sleep. So I've put myself through this like a living experiment. So I've tried to optimize myself by clean eating, structured sleep, intense workouts, breath work, mindfulness, biohacking, and on paper, I look like a prime example, everyone,

• 1:00:14John R. Miles?

  of someone who's trying to do everything right.

• 1:00:16Speaker 01

  John, I think you look great. I think it's working.

• 1:00:20John R. Miles?

  The thing behind it, though, is I didn't feel great. My energy was flat, my mind was foggy. At times, motivation was gone. And it wasn't that I was burned out. But I came up with this concept called the absorption gap, and I wanted to run it by you because there's this concept in soil science.

• 1:00:43John R. Miles?

  Called hydrophobic soil. It's when soil comes damaged through drought, erosion, overuse. It can't absorb water. And I'm wondering if the same thing was happening to me. I was throwing so many inputs at my body that my body couldn't absorb it. And I'm wondering if there's any link between this and the vagus nerve somehow getting blocked. The inputs are getting blocked and so it's not getting the stimulation it needs. Does any of that correlate with your research?

• 1:01:17Speaker 01

  I don't know. It correlates with a lot that we know about the vagus nerve. But what I always like to caution people about in this frame, well, first of all, full disclosure, I like you. I try to eat a balanced diet. I try to watch my weight. I try to exercise regularly. I try to get enough sleep. I meditate five minutes, 10 minutes, twice a day. I do these things because I believe the data that these lifestyle strategies are good for overall health, are good to increase vagal tone, and are good to reduce inflammation in the body. Does that mean it works through the vagus nerve? Nobody knows. And what I always like to caution

• 1:01:56Speaker 01

  people of, not you, but your listeners, are doing these healthy things is probably a safe bet, a Pascal's wager. The issue is, however, if there is an underlying structural problem, say damage to the vagus nerve, like we saw in some patients with COVID, then if the wires are damaged, right, if the connections are severed or are not functioning, then these things don't work equally well. I point this out because sometimes I see this in social media. I see this online. Well, they should, this patient with this horrible condition, rheumatoid arthritis or some other autoimmune condition, well, they should exercise more. And I cured my rheumatoid

• 1:02:40Speaker 01

  arthritis because I changed my diet and I get more sleep and my joints don't hurt anymore. Good for those people that can do these lifestyle changes and have Some benefit to their health. But shame on them for hinting or blaming the patient when we just don't know everything about the underlying cause. There may be an underlying condition in the vagus nerve of some patient where the only way to reactivate those signals is going to be to put an immunoregulator, a device, directly on the vagus nerve and reanimate those signals with 400 microamps. And that may not be able to be accomplished with a few extra sit-ups or push-ups. So I see both sides of this.

• 1:03:24Speaker 01

  You can structure very interesting psychological arguments about mind and body, brain and body connections. I tend to actually believe that illness in the body 100% affects the brain and illness in the brain 100% affects the body. My favorite conversation on this topic was actually with the Dalai Lama some years ago when I presented this idea of the vagus nerve stopping inflammation as a helpful thing to him. And we're standing on a stage in front of about 1,000 people in Phoenician, New York at his facility there on the top of a beautiful mountain. And he asked me, "This vagus nerve, where is it?"

• 1:04:08Speaker 01

  And I told him, "It runs from the brain, down both sides of the neck, across the chest and abdomen." And he said, "Is there one or two?" I said, "There's two." And he said, "Is it in the front or the back?" I said, "It's in the front." And then he smiled at me and nodded, and we went on to something else. Afterwards, I was still standing on stage and a monk came up to me wearing bright orange robes, I'll never forget it. And he said to me, "Do you know why His Holiness asked you those questions?" And I said, "No." He said, "Because there's an Indo-Tibetan ancient meditative practice that envisions a cloud of energy, a cloud of blue energy over the head.

• 1:04:50Speaker 01

  And then during the meditation, we channel that down the neck on both sides, down the chest and into the abdomen." And I said, "Cool." And the monk smiled and said, "Yeah, it's very cool." And so this connectivity between state of brain and state of body is real. The vagus nerve is a critical conduit connecting them.

• 1:05:13Speaker 01

  What each vagus nerve fiber is doing with each particular intervention and modality, important research questions.

• 1:05:19John R. Miles?

  Kevin, this has been one of my most favorite conversations I've had in a long time, and your book, The Great Nerve, The New Science of the Vagus Nerve and How to Harness Its Healing Reflexes, to me is a must read. Such great work you put in that book, examples, everything else. If a listener wants to learn more about you, your work, and these recent breakthroughs, where are the best places for them to go?

• 1:05:45Speaker 01

  For the general listener, the best place I think would be, those really curious about it, start with my book that I tried to cover the basics in a very understandable language. For patients, the resources I think can be best found on the Setpoint Medical website. The other, for those in the greater New York area, we recently launched a Center for Bioelectronic Medicine at Northwell Health, and that website also has links to a phone number and a patient navigator that some patients may find very helpful.

• 1:06:20John R. Miles?

  Kevin, such an honor to have you on the show. Thank you so much for joining us.

• 1:06:25Speaker 01

  John, thanks for having me on, and congratulations on the work you do and are doing, and all the good work you've done. Thank you for having me on.

• 1:06:32John R. Miles?

  And that's a wrap. What a fascinating deep dive into the hidden superhighway that connects our brains, bodies, and healing potential. Dr. Tracy's work invites us to reconsider everything we think we know about treating disease. It reminds us that sometimes the most advanced medicine is not about creating something new, but rediscovering and activating the healing tools our bodies have had for millennia. As you reflect on today's conversation, ask yourself, is stress reduction, breath work, and meditation be doing more for your immune system than you realize? If inflammation is the common thread in so many illnesses, what simple practices could you start today to claim that fire? And how might the science of vagus nerve stimulation reshape healthcare in the decades to come? You can learn about

• 1:07:14John R. Miles?

  Dr. Tracy's work and his book, The Great Nerve, at passionstruck.com, and follow Setpoint's medical ongoing breakthroughs at setpointmedical.com. Want to watch the full interview? Head over to our YouTube channel. Subscribe so you'll never miss a conversation like this. Coming up next on Passion Struck, Christopher Wong Mickelson and Jennifer Toasty-Crares join me for a timely and insightful conversation on meaningful work, exploring how to align your career with your values, navigate burnout, and reclaim a sense of purpose in what you do every day.

• 1:07:46Speaker 02

  When we feel our work is deeply meaningful, we are less sensitive to maximizing our rewards that we get from it. For example, if I'm paid, if I'm doing a task that's deeply meaningful, and I know that I have, I'm being paid on a per task basis, like a piece rate kind of compensation scheme, I will do more work, the more meaningful my work. I'm not totally insensitive to money. I'm not totally clueless about money. If it stands to be more money made, I'll expend more effort. The interesting thing that we were able to disentangle in our study, though, is the same relationship held when workers were salaried, meaning I can do more work, but I'm not necessarily additionally compensated for it.

• 1:08:27John R. Miles?

  Thank you for being part of this movement. Your commitment to growth and intentional living fuels everything we do. And remember, the fee for this show is simple. If something resonated with you, share it with someone who needs to hear it. Until next time, live life. Passion struck.