Testosterone Erectile Dysfunction Nitric Oxide

When More Testosterone Doesn’t Help Erectile Health – Part 1 of 2

The role of vascular health on male sexual function

“I’m injecting 150 mg of testosterone cypionate every week. I look muscular. I have lots of energy – so much I actually need to take sleeping pills to wind down at night. So why can’t I get a good erection? What is wrong with me?”

I counsel countless men* with stories like this.

Typically, these fellows come to see me after visiting a “Low T” clinic and trying various hormones and hormone precursors. From testosterone creams to shots, to HCG (human chorionic gonadotropin), to breast cancer drugs and beyond, hormone treatments do indeed help some men with erectile dysfunction – but fewer men than you might think.

Erectile dysfunction (ED, impotence) is a fairly common medical condition, characterized by the inability to achieve and maintain a penile erection firm enough for satisfying sexual intercourse.1

I often explain to my clients with ED that testosterone is just one piece of the puzzle. ED can also be caused by dysfunctions in the nervous system (including mental health), in the adrenal glands, in metabolic function, in B vitamin status, and in endothelial health (the inner lining of the blood vessels). The latter is also known as “endothelial ED,” a commonly overlooked aspect of sexual health – and the focus of this article.

40% of men above the age of 40 are now estimated to have some degree of ED.

Although ED is more common among older men,16 it’s becoming more common among younger men as well: 40% of men above the age of 40 are now estimated to have some degree of ED.13 While an estimated 152 million men worldwide had ED in 1995, that number is expected to swell (no pun intended) to over 320 million people by 2025.17,18 It’s no coincidence that heart disease is also on the rise: ED is often a warning sign of impending cardiovascular disease.

The mechanics of erection

Tumescence (penile erection) relies on proper blood flow. During the male sexual response, blood flow into the penis through the arteries increases, as blood flow out of the penile veins decreases.2,3 This process effectively traps blood in the penis, resulting in an erection.

The issue with ED tends to be with the first part of this process – the delivery of blood into the penis. The integrity of the circulatory system – the system of “highways” by which blood circulates throughout the body – is essential for male sexual performance and satisfaction.4

A key component of a healthy circulatory system lies in an important little gas called nitric oxide.

Nitric oxide gets the blood flowing

Nitric oxide (NO) is a tiny gas molecule found throughout the circulatory system, causing relaxation of the cavernous smooth muscle of the penis as well as vasodilation (widening) of the penile blood vessels. These combined effects allow more blood to pass into the penis, causing a firmer erection.5,6

One of the biggest culprits for compromising NO levels, however, is inflammation – specifically inflammation of the endothelium (lining of the blood vessels).7 Vascular inflammation and the NO deficiency it causes are also to blame for other cardiovascular problems, like angina (chest pain), heart attacks, and strokes.

Erectile dysfunction can be a warning sign of other impending diseases

Even in “well-endowed” fellows, the vessels of the penis are relatively small compared to the arteries in other parts of the body. This makes the penile blood vessels fragile and sensitive to injury. The penis is therefore often the first place in the body to manifest the signs and symptoms of vascular disease.

If left untreated, the vascular inflammation and NO dysfunction associated with endothelial ED may begin to spread to blood vessels in other parts of the body, causing a variety of serious heart problems like angina (chest pain), heart attack, and stroke.8 Men can develop ED before they develop even so much as an elevated blood pressure reading!9 That’s why ED is sometimes referred to as “painless penile angina.”10

ED is a warning sign of poor vascular function and impending cardiovascular disease.

A shocking 70% of men with coronary artery disease (CAD) in one study reported that they had ED long before they developed any symptoms of CAD.11 ED is a warning sign of poor vascular function and impending cardiovascular disease.6,11-13

ED and CAD share many of the same risk factors, including obesity, sedentary lifestyle, smoking, high homocysteine levels, diabetes, high blood pressure, dyslipidemia (high cholesterol), and metabolic syndrome. All of these risk factors are also associated with poor NO activity.6,13-15

Won’t more testosterone help?

Testosterone plays an important role in sexual function via several mechanisms, including the stimulation of NO release,23 but it’s unlikely to control endothelial ED on its own for very long.

For some people with endothelial ED, testosterone replacement therapy (TRT) may help, but not sufficiently unless the dosage is ramped up high – too high. Guys on too much testosterone often experience irritability, anxiety attacks, insomnia, or other symptoms of testosterone overdose. Because of the hormone’s influence on red blood cell (RBC) production, furthermore, guys on TRT are at high risk of life-threatening events like blood clots, chest pain, heart attacks, and strokes. They’re also prone to acne, “backne” (pimples on the back), a reddish complexion, and/or a puffy appearance – effects that make a guy look a bit like the Kool-Aid Man.

For many fellows with endothelial ED, even high doses of testosterone won’t cause strong erections.

For many fellows with endothelial ED, however, even high doses of testosterone won’t cause strong erections, which does not mean that the man’s penis is “broken!”

If you have endothelial ED, it’s important to understand how and why your blood vessels are dysfunctional. Yes, there are of course nutritional supplements you can take to enhance nitric oxide production, but they’re unlikely to give you the best outcomes unless you’re also taking care to stop the cause(s) of your vascular inflammation. This is where diet and lifestyle become non-negotiable.

In the next post, we take a look at some healthy strategies for improving endothelial health, increasing nitric oxide levels, and achieving strong erections.

Improving Erectile Health – Part 2 of 2

Nitric oxide support for sexual health

In Part 1 of this series, we looked at the physiology of a type of erectile dysfunction (ED) known as endothelial ED and explained the importance of blood vessel health on male sexual function. This week, we will explore some natural strategies, that have good scientific evidence for improving vascular (and erectile) integrity.

Although not all men with ED have endothelial ED, many of them do. Nevertheless, just about everyone can likely benefit from these suggestions:

Eat vegetables – especially beets

Diets rich in vegetables have been shown to support overall heart health,[1],[2] lowering the risks of high blood pressure, heart attack, and stroke.[3],[4],[5] If you’re not eating vegetables – it’s never too late to start!

Make at least half of your plate at every meal greens (spinach, kale, chard, etc.) and/or brightly colored vegetables like purple cabbage, tomatoes, purple onions, carrots, and peppers. Beets (beetroot) are particularly effective in increasing nitric oxide (NO) levels, as they’re rich in nitrates, antioxidants, and phenolic compounds important for cardiovascular health.[6] Beets have been observed to increase NO levels and lower blood pressure readings in both men and women of various ages.[7],[8],[9]

Beets have been observed to increase NO levels and lower blood pressure readings in both men and women of various ages.

A powdered greens and/or powdered beetroot supplement (organic whenever possible!) can be a quick and easy way to consume more dietary nitrates.

Enjoy berries

Rich in flavonoids and antioxidants, blueberries, cherries, goji berries, and other berries are excellent for vascular health. Organic green tea, and dark chocolate can also fight oxidative stress, reverse endothelial dysfunction, and stave off cardiovascular diseases.[10]

Nix commercial mouthwash and stomach-reducing medicines

The brilliant human body converts the nutrients found in vegetables into NO. This conversion requires the presence of the right kind of bacteria in the mouth and enough stomach acid.[11]

Because most commercial mouthwashes kill both the good and the bad bacteria in the mouth, they may be contributing to endothelial ED and vascular diseases.

I also typically advise my clients to stay away from calcium carbonate tablets, omeprazole, and other medications that dampen stomach acid production.[12],[13],[14] (If you have acid reflux and think you need acid-reducing drugs, read this.)

L-arginine

The amino acid L-arginine is the raw material from which the body produces NO.[15] Low blood levels of L-arginine have unsurprisingly been correlated with poor NO production, and a significant percentage of ED patients have low levels of L-arginine and/or its precursor, L-citrulline.[16]

A significant percentage of ED patients have low levels of L-arginine and/or its precursor, L-citrulline.

L-arginine supplements may improve NO levels and erectile health – but with limited efficacy, as L-arginine only stays in the circulation for milliseconds at a time.[17] This may be why a review of L-arginine’s efficacy in the treatment of ED reports that a minimum dosage of 3 grams daily is necessary to achieve outcomes, and some studies have even dosed the amino acid at 5 grams.[18]

Thankfully, there is evidence that L-arginine may work significantly well when supplemented along with glutathione (GSH),[19] vitamin C,[20] pine bark extract,[21],[22] and/or L-arginine’s precursor, L-citrulline.

L-citrulline

L-citrulline is named for the watermelon, or Citrullus vulgaris, from which it is derived.[23] Unlike L-arginine, L-citrulline skips pre-systemic metabolism and effectively increases circulating NO levels.[24],[25] This might make L-citrulline a more advantageous nutritional supplement than L-arginine in the treatment of ED, hypertension, and related vascular conditions.[26],[27] It has also been shown to be an effective adjuvant to treatment with pharmaceutical PDE5 inhibitors (drugs like Sildenafil).[28]

What may be even more effective than L-arginine or L-citrulline monotherapy, however, is taking the two amino acids concurrently: Simultaneous oral supplementation of 1 gram of L-arginine and 1 gram of L-citrulline was shown to increase plasma L-arginine levels more than 2 g of either alone in a 2017 study.[29]

Caution: Because many viruses – including herpes simplex virus (HSV) – are dependent upon arginine for replication, L-arginine and L-citrulline supplements may be poorly tolerated by patients with frequent HSV outbreaks.[30]

French maritime pine bark extract

A standardized pine bark extract (SPBE) from the bark of the French maritime pine, Pinus pinaster – or Pycnogenol®, as it’s known in the U.S.A. by its patent name – has been shown to improve erectile function both as a standalone treatment and in combination with L-arginine.[31],[32]

SPBE has been observed to support the production and release of NO from the cells lining the blood vessels, improving forearm blood flow in humans in one study.[33]

SPBE has also been shown to improve erectile function, both as a standalone treatment and in combination with L-arginine.[34],[35] In one trial, for example, supplementation with SPBE (120 mg daily for three months) significantly reduced patients’ ED severity from moderate to mild.[36] The Pycnogenol group in this study was also observed to have increased plasma antioxidant activity and reduced total cholesterol and LDL-cholesterol levels as compared to the placebo group. These findings suggest that SPBE may not only treat ED, but also improve overall cardiovascular health.[37]

In another study of 40 males 25 to 45 years of age, a combination of L-arginine and Pycnogenol significantly outperformed Pycnogenol alone, helping 80% of men (and, after another month of the study, 92.5% of men) achieve a normal erection – as compared to only 5% of men who benefitted from Pycnogenol alone. Pycnogenol was given at a dose of 40 mg one to three times daily, with L-arginine at a dose of 1.7 g daily.[38]

A combination of L-arginine and Pycnogenol significantly outperformed Pycnogenol alone, helping 80% to 92.5% of men achieve a normal erection.

In a similar trial of 50 males, L-arginine (3 g per day) plus pycnogenol (80 mg per day day) restored normal erectile function after just one month of supplementation. Sperm quality improved in the men who took this combination and their testosterone levels increased significantly, thus suggesting enhanced fertility. The men also reported a doubling in their sexual intercourse frequency.[39]

Glutathione and other antioxidants

As the master antioxidant of the body, glutathione (GSH) strongly protects against the oxidative stress associated with endothelial dysfunction. GSH and other antioxidants may thus prevent oxidative stress, ameliorate vascular endothelial dysfunction, and stave off cardiovascular disease (among other chronic ailments).[40]

Supplementation with L-citrulline and GSH has also been shown to synergistically increase NO levels.[41]

DHEA

The steroid hormone precursor dehydroepiandrosterone (DHEA) enhances sex hormone production and positively effects NO levels, thus supporting endothelial health.[42]

A systematic review of 38 trials found that DHEA improves various aspects of sexual health.

A systematic review of 38 trials found that DHEA improves various aspects of sexual health in both males and females, including sexual interest, sexual frequency, lubrication, arousal, pain, and orgasm.[43] DHEA can also help with brain health.[44]

Avoid refined sugars and refined carbohydrates

Foods like breads, pastas, commercial pastries, candy bars, so-called “sports” drinks, sodas, most juices, cereals, crackers, and potato chips all increase blood glucose (sugar) levels and drive inflammation in the blood vessels. It’s no coincidence that men with diabetes and pre-diabetes are more likely to have ED than other guys.[45],[46]

Quit smoking and drinking

You know that smoking and drinking alcohol are harmful for your health, as does everybody else under the sun! These habits also create very high levels of inflammation and oxidative stress in the body, thus wreaking havoc on the circulatory system.[47],[48] ED may be a sign that it’s time to make some healthy lifestyle changes.

Mindfulness practice

NO helps with more than just the dilation of blood vessels: it also supports immune function, balances the nervous system,[49] and protects against various types of dementia.[50] NO helps us feel more relaxed, in turn supporting further NO production.[51] In fact, experienced meditators were found to have higher levels of NO precursors in their blood than non-meditators, in one study.[52]

Move your body

A sedentary lifestyle is a significant risk factor for ED and other cardiovascular diseases. Exercise is the number one lifestyle factor most strongly correlated with erectile health.[53]

Exercise is the number one lifestyle factor most strongly correlated with erectile health.

A review of ten studies found that moderate to vigorous aerobic exercise (four times weekly for six months) improved erectile function in men with ED caused by sedentary lifestyle, obesity, high blood pressure, cardiovascular disease, and/or metabolic syndrome.[54]

Physical activity is an effective way to prevent – and likely treat – ED because it increases NO levels, improves vascular function,[55] and increases testosterone.[56] Considering that exercise helps with a wide array of other health conditions, physical activity should be a part of just about every person’s day. (Too busy to move? Read our tips for fitting exercise into your day.)

Conclusion

During male sexual arousal, nitric oxide (NO) delivers blood to the penis, resulting in erection. Erectile dysfunction may therefore sometimes be a symptom of poor circulatory health, high vascular inflammation, and/or low nitric oxide (NO) levels – all of which can predispose a man to more serious problems like high blood pressure, angina, heart attack, and stroke. ED can therefore serve as an important warning signal of bigger problems to come.

Thankfully, some simple, natural strategies can make all the difference.

Note: The words “man,” “guy,” “fellow,” and “male” as used within this article refer specifically to individuals who were born with XY chromosomes and a penis. I acknowledge and honor that not all men are born with this anatomy, and that not all people born male identify with that gender.

How to Stimulate the Vagus Nerve

Over the years and most recently, I have posted a number of articles and posts about the Vagus Nerve and its connection to Heart, inflammation, Microbiome Gut, Brain, Memory, Cognition etc. This article written by Jordan Fallis, provides excellent information and perspective allowing you the opportunity to remain healthy.

How to Stimulate Your Vagus Nerve for Better Mental Health

“By developing an understanding of the workings of your vagus nerve, you may find it possible to work with your nervous system rather than feel trapped when it works against you.”

— Dr. Arielle Schwartz, Clinical Psychologist

Stimulating my vagus nerve has played a key role in the management of my mental health over the years.

What exactly is the vagus nerve?

Originating from the Latin word “wanderer”, the vagus nerve lives up to its name as the longest nerve in the entire body. As the tenth cranial nerve,the Vagus is a major player in the parasympathetic (rest & digest) nervous system connecting your brain to the heart, gut (intestines and stomach) heart and lungs influencing heart rate, breathing ,memory, cognition and a host of other conditions.

Vagal tone

Vagal tone is an internal biological process that represents the activity of the vagus nerve. The tone of the vagus nerve is key to activating the parasympathetic nervous system. Vagal tone is measured by tracking your heart-rate alongside your breathing rate. Your heart-rate speeds up a little when your breathe in, and slows down a little when you breathe out. The bigger the difference between your inhalation heart-rate and your exhalation heart-rate, the higher your vagal tone. Higher vagal tone means that your body can relax faster after stress.

What is high vagal tone associated with?

High vagal tone improves the function of many body systems, causing better blood sugar regulation, reduced risk of stroke and cardiovascular disease, lower blood pressure, improved digestion via better production of stomach basic and digestive enzymes, and reduced migraines. Higher vagal tone is also associated with better mood, less anxiety and more stress resilience. One of the most interesting roles of the vagus nerve is that it essentially reads the gut microbiome and initiates a response to modulate inflammation based on whether or not it detects pathogenic versus non-pathogenic organisms. In this way, the gut microbiome can have an affect on your mood, stress levels and overall inflammation.

What is low vagal tone associated with?

Low vagal tone is associated with cardiovascular conditions and strokes, depression, diabetes, chronic fatigue syndrome, cognitive impairment, and much higher rates of inflammatory conditions. Inflammatory conditions include all autoimmune diseases (rheumatoid arthritis, inflammatory bowel disease, endometriosis, autoimmune thyroid conditions, lupus and more).

How do we increase vagal tone?

But what you really need to pay special attention to is the “tone” of your vagus nerve.
Vagal tone is an internal biological process that represents the activity of the vagus nerve.

Increasing your vagal tone activates the parasympathetic nervous system, and having higher vagal tone means that your body can relax faster after stress.

In 2010, researchers discovered a positive feedback loop between high vagal tone, positive emotions, and good physical health. In other words, the more you increase your vagal tone, the more your physical and mental health will improve, and vice versa (5).

“It’s almost like yin and yang. The vagal response reduces stress. It reduces our heart rate and blood pressure. It changes the function of certain parts of the brain, stimulates digestion, all those things that happen when we are relaxed.”

— Dr. Mladen Golubic, MD, Medical Director of the Cleveland Clinic
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What’s interesting is that studies have even shown that vagal tone is passed on from mother to child. Mothers who are depressed, anxious and angry during their pregnancy have lower vagal activity. And once they give birth to their child, the newborn also has low vagal activity and low dopamine and serotonin levels (1-3).

Your vagal tone can be measured by tracking certain biological processes such as your heart rate, your breathing rate, and your heart rate variability (HRV). When your heart rate variability (HRV) is high, your vagal tone is also high. They are correlated with each other.

You can increase your HRV by using the EmWave2 device. Some researchers actually use the EmWave2 to measure vagal tone in their studies.

NOTE: If your vagal tone is low, don’t worry – you can take steps to increase it by stimulating your vagus nerve. This will allow you to more effectively respond to the emotional and physiological symptoms of your brain and mental illness.

Stimulating the vagus nerve and increasing vagal tone has been shown to help treat a wide variety of brain and mental health conditions, including:

For people with treatment-resistant depression, the FDA has even approved a surgically-implanted device that periodically stimulates the vagus nerve. And it works (6-9).

But you don’t need to go down that route..  You can enjoy the benefits of vagus nerve stimulation naturally by following these 13 steps.

1. Cold Exposure

Acute cold exposure has been shown to activate the vagus nerve and activate cholinergic neurons through vagus nerve pathways (10).

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Researchers have also found that exposing yourself to cold on a regular basis can lower your sympathetic “fight or flight” response and increase parasympathetic activity through the vagus nerve (11).

I often take cold showers and go outside in cold temperatures with minimal clothing.

Try finishing your next shower with at least 30 seconds of cold water and see how you feel. Then work your way up to longer periods of time.

It’s painful to do, but the lingering effects are worth it.

You can also ease yourself into it by simply sticking your face in ice cold water.

2. Deep and Slow Breathing

Deep and slow breathing is another way to stimulate your vagus nerve.

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It’s been shown to reduce anxiety and increase the parasympathetic system by activating the vagus nerve (51-52).

Most people take about 10 to 14 breaths each minute. Taking about 6 breaths over the course of a minute is a great way to relieve stress. You should breathe in deeply from your diaphragm. When you do this, your stomach should expand outward. Your exhale should be long and slow. This is key to stimulating the vagus nerve and reaching a state of relaxation.

The best way to know if you’re on the right track is by using the EmWave2 device. It’s a biofeedback device that assist you in pacing your breathing. I previously wrote about the benefits of using the device here.

3. Singing, Humming, Chanting and Gargling

The vagus nerve is connected to your vocal cords and the muscles at the back of your throat.

Singing, humming, chanting and gargling can activate these muscles and stimulate your vagus nerve.

And this has been shown to increase heart-rate variability and vagal tone

I often gargle water before swallowing it. This is discussed more in Dr. Datis Kharrazian’s book, Why Isn’t My Brain Working?

4. Acupuncture

Acupuncture is another alternative treatment that has been shown to stimulate the vagus nerve (46).

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I’m a really big fan of auricular acupuncture. Auricular acupuncture is when needles are inserted into ear. I’d recommend trying to find a health practitioner in your area who provides it, especially if you’re weening off psychiatric medication. It really helped me the first time I came off antidepressants. I was surprised.

Research shows that ear acupuncture stimulates the vagus nerve, increases vagal activity and vagal tone, and can help treat “neurodegenerative diseases via vagal regulation” (45).

In my experience, ear acupuncture is more effective than regular acupuncture. I’m not sure why. I’ve just personally noticed more benefits from ear acupuncture.

I also use this acupuncture mat at home to relax before bed.

5. Yoga and Tai Chi

Yoga and tai chi are two “mind-body” relaxation techniques that work by stimulating the vagus nerve and increasing the activity of your parasympathetic “rest and digest” nervous system.

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Studies have shown that yoga increases GABA, a calming neurotransmitter in your brain. Researchers believe it does this by “stimulating vagal afferents”, which increase activity in the parasympathetic nervous system (13-18).

Researchers have also found that yoga stimulates the vagal nerve and therefore should be practiced by people who struggle with depression and anxiety (19).

Despite all the great research, I’m personally not a big fan of yoga. A lot of people swear by it but it’s just not for me. I prefer tai chi.

Tai chi has also been shown to increase heart rate variability, and researchers think this means it can “enhance vagal modulation” (20).

6. Probiotics

It’s becoming increasingly clear to researchers that gut bacteria improve brain function by affecting the vagus nerve (27).

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In one study, animals were given the probiotic Lactobacillus Rhamnosus, and researchers found positive changes to the GABA receptors in their brain, a reduction in stress hormones, and less depression and anxiety-like behaviour.

The researchers also concluded that these beneficial changes between the gut and the brain were facilitated by the vagus nerve. When the vagus nerve was removed in other mice, the addition of Lactobacillus Rhamnosus to their digestive systems failed to reduce anxiety, stress, and improve mood (25).

Another study found that the probiotic Bifidobacterium Longum normalized anxiety-like behavior in mice by acting through the vagus nerve (26).

I personally take the probiotic Prescript Assist. It’s my favourite probiotic.

But it doesn’t contain Lactobacillus Rhamnosus and Bifidobacterium Longum, which were used in the above studies. Here is one probiotic supplement that contains both. This one also contains both.

I previously wrote about some other ways you can increase the good bacteria in your gut. You can read about that here.

7. Meditation and Neurofeedback

Meditation is my favourite relaxation technique and it can stimulate the vagus nerve and increase vagal tone.

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Research shows that meditation increases vagal tone and positive emotions, and promotes feelings of goodwill towards yourself (22, 23).

Another study found that meditation reduces sympathetic “fight or flight” activity and increases vagal modulation (21).

“OM” chanting, which is often done during meditation, has also been shown to stimulate the vagus nerve (24).

I couldn’t find any research demonstrating this, but in my experience, neurofeedback significantly increased my heart-rate variability and vagal tone as measured by my EmWave2.

Now that I’m done neurofeedback, I use the Muse headband to meditate. Similar to neurofeedback, it gives you real-time feedback on your brainwaves. I previously wrote about it here.

8. Omega-3 Fatty Acids

Omega-3 fatty acids are essential fats that your body cannot produce itself. They are found primarily in fish and are necessary for the normal electrical functioning of your brain and nervous system.

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They often appear in most of my posts because they are so critical for brain and mental health and affect so many aspects of wellness.

They’ve been shown to help people overcome addiction, repair a “leaky brain”, and even reverse cognitive decline.

But researchers have also discovered that omega-3 fatty acids increase vagal tone and vagal activity (35-37, 40).

Studies shown that they reduce heart rate and increase heart rate variability, which means they likely stimulate the vagus nerve (34, 38, 39).

And high fish consumption is also associated with “enhanced vagal activity and parasympathetic predominance” (35).

This why I eat lots of wild-caught salmon and supplement with this krill oil.

9. Exercise

I’ve already discussed how exercise increases your brain’s growth hormone, supports your brain’s mitochondria, and helps reverse cognitive decline.

But it’s also been shown to stimulate the vagus nerve, which may explain its beneficial brain and mental health effects (28).

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Many brain health experts recommend exercise as their number one piece of advice for optimal brain health.

This is my exercise routine:

  • Lift heavy weights 1-4 times per week
  • High-intensity interval sprinting 1-2 times per week
  • Walk as much as I can (ideally 30-60 minutes every day)

Walking, weightlifting and sprinting are the best forms of exercise, but you should choose a sport or exercise routine that you enjoy, so that you’ll stick with it consistently.

10. Zinc

As I’ve discussed before, zinc is an essential mineral for mental health, especially if you struggle with chronic anxiety.

One study shows that zinc increases vagus nerve stimulation in zinc-deficient rats (41).

It’s estimated that 2 billion people in the world are deficient in zinc, and six different studies show that subclinical deficiency of zinc impairs brain function in children and adults (42-44).

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So, if you struggle with a brain or mental health disorder, it’s quite possible that you’re deficient.

Some of the best food sources of zinc include oysters, grass-fed beef, pumpkin seeds, cashews, mushrooms and spinach.

However, I still recommend at least short-term supplementation to ensure you get enough. I regularly supplement with zinc picolinate, one of the most absorbable forms of zinc, especially after any alcohol consumption. You can get it here or here.

It’s also available in this high-quality multimineral.

Check out my previous post about zinc and copper if you’re interested in discovering more steps you can take to increase your zinc levels.

11. Massage

Research shows that massages can stimulate the vagus nerve, and increase vagal activity and vagal tone (31-32).

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The vagus nerve can also be stimulated by massaging several specific areas of the body.

Foot massages (reflexology) have been shown to increase vagal modulation and heart rate variability, and decrease the “fight or flight” sympathetic response (29).

Massaging the carotid sinus, an area located near the right side of your throat, can also stimulate the vagus nerve to reduce seizures (30).

I personally get a massage from a registered massage therapist every couple of months.

12. Socializing and Laughing

I’ve already discussed how socializing and laughing can reduce your body’s main stress hormone.

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And now I’ve learned that they are likely doing this by stimulating the vagus nerve.

Researchers have discovered that reflecting on positive social connections improves vagal tone and increases positive emotions (47, 48).

Laughter has been shown to increase heart-rate variability and improve mood (49).

And vagus nerve stimulation often leads to laughter as a side effect, suggesting that they are connected and influence one another (50).

So my advice is to hang out and laugh with your friends as much as possible. Although I should probably be taking my own advice here, as I’m an introvert and often avoid socializing too much.

13. Intermittent Fasting

On most days, I don’t eat breakfast at all, and then “break my fast” by eating my first meal of the day around 2 or 3 p.m. That means I eat all my food for the day within an 8-hour window.

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There are many health benefits to doing this. As I’ve discussed before, intermittent fasting can boost your brain’s growth hormone, improve mitochondrial function, and may help some people overcome brain fog and cognitive decline.

Research also shows that fasting and caloric restriction increase heart rate variability, which is an indicator that it increases parasympathetic activity and vagal tone (33).

The best way to start fasting is simply by eating dinner around 6, not eating anything after that before bed, and then eating a regular breakfast the next day. That should give you about 12-14 hours of fasting time.

Conclusion

You don’t have to be controlled by your body and mind. You have the power to tell them what to do.

By stimulating the vagus nerve, you can send a message to you body that it’s time to relax and de-stress, which leads to long-term improvements in mood, wellbeing and resilience.

Increasing my vagal tone has allowed me to overcome anxiety and depression, and better manage them when they arise.

Overall, I hope you implement some of the above steps into your daily life, and they allow you to live more optimally.

Live Optimally,

Jordan Fallis

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First of all, the vagus nerve is the longest nerve in the body which originates in the brain as cranial nerve ten, travels down the from go the neck and then passes around the digestive system, liver, spleen, pancreas, heart and lungs. This nerve is a major player in the parasympathetic nervous system, which is the ‘rest and digest’ part (opposite to the sympathetic nervous system which is ‘fight of flight’).

Vagal tone

The tone of the vagus nerve is key to activating the parasympathetic nervous system. Vagal tone is measured by tracking your heart-rate alongside your breathing rate. Your heart-rate speeds up a little when your breathe in, and slows down a little when you breathe out. The bigger the difference between your inhalation heart-rate and your exhalation heart-rate, the higher your vagal tone. Higher vagal tone means that your body can relax faster after stress.

What is high vagal tone associated with?

High vagal tone improves the function of many body systems, causing better blood sugar regulation, reduced risk of stroke and cardiovascular disease, lower blood pressure, improved digestion via better production of stomach basic and digestive enzymes, and reduced migraines. Higher vagal tone is also associated with better mood, less anxiety and more stress resilience. One of the most interesting roles of the vagus nerve is that it essentially reads the gut microbiome and initiates a response to modulate inflammation based on whether or not it detects pathogenic versus non-pathogenic organisms. In this way, the gut microbiome can have an affect on your mood, stress levels and overall inflammation.

What is low vagal tone associated with?

Low vagal tone is associated with cardiovascular conditions and strokes, depression, diabetes, chronic fatigue syndrome, cognitive impairment, and much higher rates of inflammatory conditions. Inflammatory conditions include all autoimmune diseases (rheumatoid arthritis, inflammatory bowel disease, endometriosis, autoimmune thyroid conditions, lupus and more).

How do we increase vagal tone?

In the article above, vagal tone was increased through a device that stimulated the vagus nerve. The good news is that you have access to this on your own, but it does require regular practice. To some degree, you are genetically predisposed to varying levels of vagal tone, but this still doesn’t mean that you can’t change it. Here are some ways to tone the vagus nerve:

  1. Slow, rhythmic, diaphragmatic breathing. Breathing from your diaphragm, rather than shallowly from the top of the lungs stimulates and tones the vagus nerve.
  2. Humming. Since the vagus nerve is connected to the vocal cords, humming mechanically stimulates it. You can hum a song, or even better repeat the sound ‘OM’.
  3. Speaking. Similarly speaking is helpful for vagal tone, due to the connection to the vocal cords.
  4. Washing your face with cold water. The mechanism her is not known, but cold water on your face stimulates the vagus nerve.
  5. Meditation, especially loving kindness meditation which promotes feelings of goodwill towards yourself and others. A 2010 study by Barbara Fredrickson and Bethany Kik found that increasing positive emotions led to increased social closeness, and an improvement in vagal tone.
  6. Balancing the gut microbiome. The presence of healthy bacteria in the gut creates a positive feedback loop through the vagus nerve, increasing its tone.
  7. Qigong, Tai Chi, Yoga, Chill Out, (added by Dr. P)

The implications of such simple and basic practices on your overall health, and in particular on inflammation are far-reaching. If you suffer from an inflammatory condition, digestive upset, high blood pressure or depression, a closer look at vagal tone is highly recommended. We’ve known for years that breathing exercises and meditation are helpful for our health, but it is so fascinating to learn the mechanism by which they work. I hope this short article has inspired you to begin a meditation practice, as it has for me, and also to look for other means to manage the body’s inflammatory response.

NOTE: Chiropractic Adjustments are infamous for stimulating the Vagus Nerve as it passes close to the Cervical 1 Vertebrae (Atlas)

Additional Links:

How to Stimulate the Vagus Nerve for Better Optimal Health

Vagus Nerve Stimulation Dramatically Reduces Inflammation

Here’s how stress in your brain may cause heart troubles

Transcendental Meditation

Full Catastrophe Living written by the developer of this technique Jon Kabat-Zinn

I have asked my folks to purchase the book Human Heart/Cosmic Heart by Thomas Cowan MD to further their understanding of how the heart works and what we can do to prevent America’s # 1 killer heart disease

 

References:

Forsythe P, Bienenstock J, Kunze WA.Vagal pathways for microbiome-brain-gut axis communication. Adv Exp Med Biol. 2014;817:115-33.

Kok, B, Fredrickson, B, Coffey, K, et al. How Positive Emotions Build Physical Health: Perceived Positive Social Connections Account for the Upward Spiral Between Positive Emotions and Vagal Tone. Psychological Science 2013 24: 1123