E110: Vagus Nerve Exercises with Dr. Kimberly Hindman (part 2)

E110: Vagus Nerve Exercises with Dr. Kimberly Hindman Jill Brook: [00:00:00] Hello fellow POTS patients and lovely people who care about POTS patients. I'm Jill Brook, your horizontal host, and today we have part two of our discussion with Dr. Kimberly Hindman. You may recall that last time she told us about the really fascinating science behind the cell danger response theory where our cells may get stuck in a danger response state and not bounce back to normal functioning and healing after an emergency. She discussed polyvagal theory. Which says we have a third possible state beyond just the fight or flight state versus the rest in digest state. And that theory posits that we also have a free state that can make us do the human equivalent of playing dead when things get too exhausting or overwhelming. And then she gave us the science behind the limbic system of the brain, which works to assess risk and remember those risks or to stay [00:01:00] vigilant to these risks to avoid danger. But she talked about how sometimes it can function like a dog that barks at everything instead of only barking at the actual threatening things. Dr. Hindman talked about how these three things may be interrelated and contributing to chronic illness in some people, including POTS and MCAS patients. If you haven't yet listened to that episode, I highly recommend it, because today Dr. Hindman is going to start sharing practical exercises that we can do to help break out of these vicious cycles. You may recall that Dr. Hindman is a naturopathic physician and licensed acupuncturist in Portland, Oregon. She was trained at the College of William and Mary and then Duke University and then National College of Naturopathic Medicine. You may recall that she herself has POTS, Hyper Mobile EDS, MCAS, and had surgery [00:02:00] for occult tethered cord. So she really knows this stuff. She teaches it to other practitioners as well as her own patients. I am so excited to learn from her today. Dr. Hindman, welcome. Thank you for coming back. And did I get that summary right? Dr. Kimberly Hindman: You got it. Great. That was spot on. Yeah. Jill Brook: Well thank you so much. So I know today we're gonna focus on exercises for the vagus nerve. Can you tell us again why we would wanna do that? Dr. Kimberly Hindman: So the vagus nerve, there's two branches of it. So the one branch we associate with that kind of rest, digest, feeling calm, feeling happy, having social engagement, the place really we wanna be and the place we need to be if we wanna have any healing happen. This is where we feel safe in our bodies, and so we can connect with other people, share stories, shared meals. This is where like group culture comes from because we're connected with each other. So we as individuals feel safe and we have a [00:03:00] safety sense in our community, and we can grow and build in that. The other branch of the Vagus nerves, that dorsal branch, that means the back part of it. That's our freeze response. That's basically when there's a danger. That's too big for us to fight and win and we can't run away. So we go into shutdown, and what I've seen for a lot of patients is that people will flip back and forth between the sympathetic, which is fight or flight. Everything's ramped up, everything's hypervigilant. Everything is really like go, go, go. And then when they're exhausted, they flip into them this dorsal Vagus state where they're just, they're wipe. It's not just, Oh, I need a couple days to rest and recoup. I did too much. Everything is really shut down. So we get mental shutdown, social shutdown, emotional shutdown, physical. I can't get off the couch, kind of shut down and they flip flop back between those two. But they never get into that good place that we want for healing to happen. And that's important because both of those states are danger states. So [00:04:00] no healing is gonna happen during that time period. So what we need to do is stimulate the part of the vagus nerve that we want, because when that part is active, it automatically shuts off the other parts. So we don't have to worry about tamping those down. We just need to get the ventral meaning front, part of the vagus nerve, that branch just going. And if it does that's all we need to do to get that vagus balance again. So all of that is in the autonomic nervous system. So when we talk about like dysautonomia, it means the autonomic nervous system, the part that's outside of our control is not functioning correctly. And so we need this vagus nerve to be functioning correctly because this has a huge impact on our immune function, on all of our digestive function, all of our internal organs. All of that relies on good vagus nerve functioning, and then just healing in general for our bodies requires that too. Jill Brook: So I think what you're saying is that this is almost like a hack because you can stimulate a physical nerve [00:05:00] to get into the state that you want to be in the rest and digest or the parasympathetic, you don't actually have to take away the environment or the situation that was stressing you out to begin with? Is that what you're saying? Dr. Kimberly Hindman: If you're still in an actively stressful environment, it may not be as effective, but it certainly will be helpful. And so if some of these are things that people can do, Really easily day to day basis. That may help if they are in ongoing stressful situations. I do find that if somebody is still dealing with something ongoing in terms of like a chronic infection, a heavy metal, something like that, it's still important to do these because it may lessen the impact on the nervous system overall. We may not see as much of a benefit until we get those other factors completely cleared out. The challenge is that if the nervous system has gotten dysfunctional, because of all of those threats, that dysfunction can keep going [00:06:00] even after those threats are gone. So for some people, they may find, they go in and they get testing done, imaging done, lab work done, and it's all normal. They don't find anything. So they're told they're fine, which they're not because they're still having all of these. It may be because of this nervous system dysfunction, and that may be driving everything. And that's why we can't find anything on the testing that we're doing because we're not looking for this. There's no imaging that we can do that says, Oh, what's your Vagus nerve doing? And so that's where people can get into really challenging situations of still having symptoms and not knowing why. Jill Brook: Right. Okay. Yes. And that resonates with me that the danger can pass. There is no more danger anymore, but your body doesn't seem to get that message. Dr. Kimberly Hindman: Right, because it's been under danger for so long or has had so many dangers at the same time, if there's like infection and metals, if there's been an injury on top of an infection, like if you've got mixed things then yeah, that's a lot. And our systems were not designed to deal with that much, and especially for [00:07:00] that long. They were designed for short. You get over it, you're done. You get back to healing and off you go. So even when those things are cleared up, the nervous system has seen that for so long that it's like, Oh, okay, well that's my new baseline. And we have to retrain to say, No, no, no. We want you to be in a different place and you can. So here's how we want you to get there. Jill Brook: Excellent. Yeah. Okay. What do you got? What's number one? Dr. Kimberly Hindman: so I'm gonna give you a list of things that I've got. And I wanna pull out some of them that I think just have some interesting information that I wanna share about them. And then I have some actual exercises that I'm gonna walk you through that are from Dr. Stanley Rosenberg. So he's the one who wrote the book Accessing the Healing Power of the Vagus Nerve. That is a great book. I would highly recommend that because it's got these exercises that are so easy to do and anybody can do them. And so I'm gonna go through two of them just so people can kind of play with them a little bit and see, and then if they want more, they can go to his book and get more there. So I'll just run through the list kind of quick and then [00:08:00] we'll go through some of the other things. So probiotics and Omega threes, breathing. But I will talk about breathing, meditation, yoga, laughter, which is one I definitely wanna talk about cause that's really interesting. Acupuncture, aroma point therapy, which I'll talk about. And aroma therapy, exposure to cold. And that doesn't mean we all have to become like polar bears and drop into ice, that we can work with that to people's tolerance. Cuz I realize that especially for patients with POTS and MCAS, sometimes temperature can be a trigger and temperature change can be a trigger. Singing, gargling or gagging, Sleeping on your right side, Rubbing your belly, rocking, joint rotations using a weighted blanket. Acetylcholine support, and I'll definitely talk about that one more. Epsom salt baths, using an earthing sheet. So that's from earthing.com. Getting outside nature or standing barefoot on the earth, actually skin to skin contact with someone you trust. Can be [00:09:00] really, really profound. And I think that's part of where especially for newborns and for infants, they talk about having skin, skin contact with your baby. Part of that is to help get that vagus nerve set so that, oh, my baseline is, Oh, I feel so good. I feel safe. I feel like and that's good for moms or dads or whoever's loving this child as well because it has the same impact on us. Body brushing with a sensory brush. You can get them all over the place. They use them a lot in occupational therapy, especially for children who have sensory processing disorders. It's almost like a little plastic bristle, but they're really, really soft. So if you put any pressure on it, the bristle is actually flattened. So they're not hard, they're not spiky. And one of the things I like about that is you just hold it in your hand. It's very small and you can use as much pressure as you want. You can do it anywhere on your body that you want. If you do it really light, you can also get some of the lymphatic movement, which is always nice. But with that, we're using the sense of touch, kind of like with the skin to skin contact to get that sensory input into the vagus nerve of, Oh, [00:10:00] that feels good. Oh, okay. I can use that sense to get that information to the vagus nerve. I would say the same thing happens then when we pet our animals. The same kind of thing. And sometimes laying on the floor with a pool noodle under length-wise, under your spine and just letting yourself relax over that can also be really, really lovely for the vagus nerve. So I wanna go through and just touch on some of these. Jill Brook: Yeah, so excellent. That's so many wonderful things. So we're gonna go through 'em one by one in a little more detail. Dr. Kimberly Hindman: I was gonna say, cause I pulled out some of the ones that I have more information on. For something like yoga, I'm not gonna talk about a whole lot cuz that's a whole topic in and of itself. I would say though, for patients with EDS, work with somebody who knows that you have EDS. Yoga is not like forbidden for patients with EDS. It's something that you have to really work with somebody who can help you get to the posture you're supposed to be in, not the posture you can get into and recognize that more is not better for these patients. they're gonna help you to get to, Okay, Like I can look at you and say, Yep, [00:11:00] that's right. So then you develop the muscle memory of this is where I need to stop. My joint may be able to go further, but I'm gonna stop. So so with probiotics, I just wanna point out that patients with MCAS or histamine intolerance maybe need to be aware of different probiotic strains because some will increase or decrease histamine. So not all probiotics are the same, especially for patients who are dealing with those kinds of issues. So some of the ones that can increase it are lactobacillus kci, Bulgaris and Helveticus and streptococcus thermophilus. That's one that can be tricky to avoid because that's in a lot of them. So just be aware of those ones. Some of the ones that can decrease are the bifido bacterium infantis at Longum, Bifido and Breve, and then the Lactobacillus plantarum rhamnosus gasseri and salveris. so people can just look at those and see, which of those does mine have? And that's gonna vary for patient to patient. Some people find they can take any of them and [00:12:00] be fine, and that's great. But I also wanna let people know that if they think, Oh, that sounds great. I wanna add a probiotic. Just be aware if it doesn't seem like it's helping. Check your specific strains to see if maybe you need something that's different. And then for omega threes, just watch your source for your purity. Do they test for heavy metals? Do they test for PCBs? How is it stored? You know, if it's gonna sit in a hot warehouse somewhere and then get in a hot truck and go to another hot warehouse, it might not be in good shape by the time it gets to you. And so then that's actually not gonna be helpful. It's actually gonna be harmful because those oils might have actually started to go bad already. So with breathing, a lot of us we don't actually breathe. We take in enough oxygen so that we can function. But we don't actually breathe with our abdominal muscles and with our diaphragm, we breathe with a lot of the accessory muscles of breathing, which are up in the neck and the shoulders, and so the goal is to just do easy breathing. So natural breathing uses that diaphragm, which will just [00:13:00] create the belly breathing. We don't want people to force themselves to do deep breathing because sometimes that can lead to actually hyperventilation because people are trying to breathe too. Jill Brook: Okay. And I think they're starting to link some hyperventilation with POTS. Dr. Kimberly Hindman: Right. And so actually there's a whole method called Buteyko breathing, so it's ButeykoClinic.com. They've got some really interesting information about different breathing techniques, and they use them for respiratory issues. Sleep disorder, breathing like apnea. But they also use this for neurologic conditions, which includes anxiety, stress, and panic attacks, which I think are all indicators of vagal nerve dysfunction. So this may be something that people wanna check out. And again, they're really simple techniques. There are providers that can help people learn these, but on their website, they have a ton of information about alternating nostril breathing, like all different kinds of techniques. And one of the things that they talk about, You don't necessarily wanna just do deep breathing, it needs to be more of a regulated, [00:14:00] easy breathing. So that we're breathing the right amount cuz we don't wanna under and we don't wanna go over. Jill Brook: Okay, so we'll link to. Show notes so people can go to that. Dr. Kimberly Hindman: Yeah. Great. So for meditation, I just wanted to touch on this one. This does not have to be you sitting cross-legged on the floor. I think that's what people think of. You can be seated, you can be laying, you can be standing, you can be moving around. It's really about your state of mind. So you can meditate while you're doing the dishes, taking a shower or taking it while like doing other things. I will say that sometimes, especially if somebody's getting started with this, it can be helpful to set aside a place or have other sensory inputs. Smell, lighting, sound, touch or something that helps you to create the sensory association with a positive experience. So if it's like, Okay, I'm gonna set aside some time to meditate, and I'm gonna go and sit in this really comfortable chair and I'm gonna have my soft, cozy blanket and I'm gonna put on some music that I really like that just makes me happy and I'm gonna have the lighting at a level that works for me. After [00:15:00] a while, as you keep doing this, when you sit down in that chair, the brain goes, Oh, I know what we're gonna do and starts kind of moving in that direction already. So you can use some of these things then as cues on what you wanna meditate on. Jill Brook: So can you talk a little bit more about this state of mind, because I'm a notoriously terrible meditator, and so when you say that it's possible to meditate while you're doing the dishes, now part of me is like, Oh, that sounds so appealing. And part of me is like, Okay, so what am I going for? What does that look like? Dr. Kimberly Hindman: So I think that there are lots of different ways to meditate and I have found for myself and for a lot of other patients that just trying to just clear your mind is really hard . It's just really, really hard to just be in this kind of like completely empty state. I'm still working on it. I get it every once in a while. So I find that sometimes having a theme that I wanna focus my thoughts on is more helpful than trying to just not have any thoughts. and two of the things that I really like are gratitude. I like to then [00:16:00] take time and then really think about, okay, what and who am I grateful for? And not just I'm grateful for my family. Nope, you'll be done with that in a sentence. Think about each person. And something that I am actually grateful for about them. Maybe it's something about our relationships and that they've given to me something just that I like about them, that I'm like, I'm really grateful that this person exists in the world because of this reason. I'm grateful that I have my bed and it's comfortable and I got my pillow, and I can really think about each of these things and feel gratitude that you have for that. That's something that you can do kind of wherever the other it ties into this, We focus a lot on if we are loved or if we are lovable more than how much we love. And that can be a really great thing to do in terms of meditation and it ties in a little bit with the gratitude, but just to feel like, okay, I'm gonna take a moment. I'm just gonna focus on Jill and how much I love Jill and really think about her, our conversations, how that's made me [00:17:00] feel. And feel that love that I feel going out. It's really hard to be stressed out and in a dangerous state when you are just experiencing all of this love. Jill Brook: Yeah. Dr. Kimberly Hindman: as you are then pouring that out, it changes how you feel so that you can then just be in a state of being in love, period. Like it's not specifically directed towards a person or thing, but you can think about people, places, pets, foods, it doesn't matter. It could be anything that you feel that way about. Because when we do that, it calms our minds and it reconnects us to life around us. So it creates a feeling and an experience of community, even if it's just what I'm thinking about. Even if those people aren't here right now, doesn't matter. My brain doesn't really know that. All it knows is that I'm thinking about this person and feeling that connection and feeling that love. And that's what the ventral vagus nerve is all about, is that [00:18:00] sense of safety and love and connection and community. And I can basically tell my brain I have that. Jill Brook: That's beautiful. And to me that feels so much easier than just trying to think of nothing. So thank you for explaining that. I didn't realize that that could count as meditating. Dr. Kimberly Hindman: In my world it does. Absolutely does. And I think that because the goal is really to center and kind of calm your mind. And so if especially we have busy minds and we've got a lot going on and they have been hypervigilant. Just telling the mind to just be quiet. It's not gonna work. And then it just gets frustrating that it's like, I can't do this. Why are we talking about meditation? And this is so great, I can't do it. It doesn't work for me. And then I just end up being more frustrated at the end of it than feeling anything positive. Jill Brook: I'm so glad you said that cuz just as a funny thing, my brain does not turn off. And so the best that I have been able to do is to put on like some British comedy audio on like [00:19:00] 1.5 speed. And have it go so fast and have me so excited to hear every word that I will stop thinking about everything else as I try to keep up with the comedy. But you're telling me that I can do this other thing that sounds beautiful and I'm excited to do it. And yeah, you can do it anytime, anywhere. And if you're with somebody, why not tell 'em all these loving things too? Cause that sounds nice too. Dr. Kimberly Hindman: right. Exactly. And it's all true because it's how you feel and you have total control over it. So you're not sitting here thinking about then, oh well, like, who loves me? Well shoot, I gotta come up with this list. And what if I can't come up with a list that's very big? And what if I'm not sure, Like that can really spiral people downward. and I think that we can control and we do control, like how much do we love? And we get benefit when we do that. So we can use that as this kind of stepping stone to okay, brain, you wanna just keep going. That's where you are right now. That's where you are right now. I'm gonna tell you where I [00:20:00] want you to go, and I want you to go in this direction. If somebody wants to take a walk and wants to get into kind of a meditative state. Observe what you're seeing, like really connect with the nature around you. Even if it's just you're seeing the neighbors shrubbery, really look at like, Oh, those flowers are starting to bloom. Oh, like, that's such a pretty color. And like the leaves are moving in the breeze. Like really connect with these things that you're seeing because again, it gives you that sense of a place in connection and community. Even if it's community within nature, it makes it more active process. It can really have really significant impacts for us in terms of our nervous system state. Jill Brook: Love it. Beautiful. Dr. Kimberly Hindman: those are some things that people can do, and I wanted to talk about that because I do think that people see like meditation. They think, Oh, I've gotta be like in this awkward position that doesn't really work for me. And just sit here for however, and be uncomfortable and maybe be in pain and not feel good and be frustrated at the end of it. Jill Brook: Excellent. Dr. Kimberly Hindman: So I wanna talk a little bit about [00:21:00] laughter. So there's actually something called gelatology, which is the science of laughter. So people are studying this. So I looked in PubMed, which is the repository of all of the published journals, and just doing a search for laughter therapy gave 629 studies. So I want people to know this is something that's actually being looked at and really studied from a medical and scientific perspective. So there are some studies that have shown that laughter can reduce blood sugar and complications of type two diabetes. And in some of those studies they actually showed that what looked like was changing was gene expression. Jill Brook: Whoa. Dr. Kimberly Hindman: So laughter is actually changing how our genes function. So we, Right. Which I was just like, Oh my gosh, that's amazing. So we all have whatever genes we have, but we can change which ones are turned on, turned off, how much, how they function, how they interact with each other. And laughter is one of the ways that we can do that. There are some other things that showed that, like laughter showed that created cardiovascular effects. Similar to exercise, there [00:22:00] was actually a case study of laughter alone stopping a child's arrhythmia. So this child was in the er. They laughed about something and stopped. Jill Brook: Huh. Dr. Kimberly Hindman: and they had all this recorded because they had this child hooked up to all these monitors and it just normalized. Laughter can increase pain tolerance. And so there's all kinds of different things they're looking at with laughter and what they found is the benefits can be either from spontaneous laughter, Which is triggered by something external or like a positive emotion, or you see maybe this funny or self-induced, which like you actually make yourself laugh and the benefits are there whether or not there is something humorous. So if you just make yourself laugh, even if there's nothing particularly funny in the moment, your brain doesn't know that. All it knows is there's laughter. So these are then the effects that I have. So I think that this is where like if somebody is in a really dorsal Vagus state, they're exhausted, they're crashed out, and you're laying on the [00:23:00] couch, put something funny on. It doesn't matter if you've already seen it 9 million times. If it's something that makes you laugh, that actually may help shift your nervous system to actually help you to feel better. Jill Brook: That's so amazing. So some people might even check if their community has something called like laughter yoga, because when I lived in Pasadena, there was a very active group that would get together and do that, and they would spend an hour. And during like the first 20 minutes, they would do laughter exercises where they would just fake laugh in different ways. Like, we're gonna do the Santa Claus laugh, now we're gonna do the evil genius laugh. Now we're gonna do some other laugh. And it was just kind of supposed to warm up the laughter circuitry. But then they would have us lay down on the floor and they'd say, Keep your eyes open and keep your mouth open. And that's all they would say. And what happened every single time was that somebody would just start a tiny little giggle and then it would make everyone else burst out laughing. And then it would [00:24:00] roll and roll like that sometimes for like half an hour, 40 minutes until we were exhausted. But people would come back week after week cuz we really did feel effects and people would say their pain was better or their sleep was better. And this was just like a free gathering. Where I live now I don't see any groups doing anything like that, but I think they do exist somewhere. Dr. Kimberly Hindman: That's perfect. That's like exactly what I'm talking about. We should have that everywhere. Like I love that idea. And I think that we've all had this experience of being with somebody who we're really close to who does make us laugh. And if you've been with that person and you've laughed afterwards, like your bucket feels full, like you feel different inside of your own body and I find that primarily in like my chest and my belly. Like that's where I feel it and I'm thinking, Oh right, because that's where the vagus nerve is going. So you're vagus nerve now all happy and sending all these signals and everything just feels right inside. That's because I have shifted my nervous system state by talking with this friend who just absolutely cracks me up.[00:25:00] I think that spending time with people who make us laugh is a really, really good thing. And if this is something that we actually know directly affects cardiovascular function, this is even more important than for POTS. So bringing that kind of back around that, there are some systems that we know are particularly impacted by laughter and the heart is one of them. And then regulating blood pressure is gonna be the other part of it from the vagus nerve. I think that's one of those things that it may feel funny to just sit here and make yourself laugh or just laugh because there's nothing. But maybe over time, kind of like you've experienced in the class, you will start thinking of something funny that does actually make you laugh. But we just gotta get people laughing. Jill Brook: So that's something you could do when you're like alone in your car and sitting in traffic. You might as well just practice laughing. Dr. Kimberly Hindman: You could laugh, you could sit there and just like, okay, in the time it takes till the light turns green, I'm just gonna send out love to all the people I love. Like I'm just gonna start working down my list or pick one person and just be like, okay, I'm just gonna totally like send this [00:26:00] person a love bubble of all the things that I love about them. Jill Brook: Oh, I love that. Love bubble. Dr. Kimberly Hindman: So there, there are loads of things that you could do at a stoplights. The next one, not so much cuz this is about cold exposure, so that would be a little trickier to do, but that's okay. So cold exposure is known to generally increase parasympathetic tone. It's also interesting because it reduces heart rate, it increases certain proteins that have an anti-inflammatory effect. It also reduces blood sugar, it improves insulin sensitivity. There are a couple of things that I found that are really interesting to me, especially about how this relates then to vagus nerve is they did some studies with acute cold exposure in rats. And it activated neurons in the digestive tract that are actually responsible for GI motility That worked specifically through the vagus nerve. And there was another one that showed that the cold exposure actually increased pancreatic enzymes in all the digestive secretions separate from the GI motility. So if somebody has slow digestive motility, I [00:27:00] see a lot of that in patients with POTS and with MCAS. Cold exposure is actually something that can increase digestive function and motility just by itself. Jill Brook: That's amazing. How cold are we talking? Dr. Kimberly Hindman: So, I tell people to start with your tolerance. So we can do this a couple of ways. So it can be cold exposure to your face especially, or the back of your neck, because remember the vagus nerve comes out of the brain, down the neck, and then into the internal organs. And that can be just splashing the water on getting a cold washcloth. One of the things that I also like is Old school, naturopathic, hydrotherapy. We tell people to end their showers with the cool rinse and with all of these things, it has to be to somebody's tolerance. So I'll tell people with the cool rinse, just make it cooler than whatever your hot was. And at some point, if you keep doing this, that won't really feel so cold anymore, and you'll actually find you wanted a little colder and you can make it a little colder. There may be other days where you're like I don't know that I can tolerate as much, so don't do as much. Other days you're [00:28:00] like, I'm gonna be total polar bear and I wanna go cold. Great. 30 seconds is all you need though at the end of your shower. We don't do like a whole cold shower like . There may be people who wanna do that. I'm not that hardcore. So we always want it to. So that it's cold, but it's not, painful and we don't want it to be so cold that it makes somebody feel like it's flaring up their symptoms, knowing that temperature differences can be an issue. So that could be something that people can play with, and that can be, if you're at work and you just need to go to the bathroom and get a paper towel, get some cold water, put it on the back of your neck for a few minutes, that might be something that's easy. Jill Brook: Beautiful. Dr. Kimberly Hindman: So my next one I wanna talk about is the singing gargling and gagging. Jill Brook: I know which one sounds less fun than the others. Dr. Kimberly Hindman: Exactly. And that's the last one for a reason. So the laryngeal nerve controls the motion of the vocal cords, which controls our voice, and that is actually a branch directly of the vagus nerve, so we can get direct stimulation to the vagus. Through using our voice.[00:29:00] And one of the things that Dr. Rosenberg talks about in his book as a clue for assessing vagus nerve dysfunction is when somebody has a monotone voice and there's a flat sound to their voice when it doesn't go up and down in kind of a normal cadence when it's just become flat. He says that is sometimes one of the indicators that he looks for, that, Oh, maybe we've got some vagal nerve stuff going on. So singing, when you're gonna sing it though, you gotta belt it out. You gotta channel your inner Aretha Franklin, like you gotta belt it out. This isn't about how well you can sing, how on key you are, don't care. This is about getting vibration through your vocal chords, especially then to the back of your neck to get that vibration into the vagus nerve. It can't be a little hum. It's gotta be that you're in your car by yourself and nobody can hear you and it's a great song and you're just gonna sing away. Yep. Which is great because listening to joyful music or music that makes us really happy also then works for Vagus nerve. And it [00:30:00] actually, there has been some studies that have shown that just listening to joyful music can increase blood flow similar to aerobic exercise. So it's not insignificant. Gargling, same thing. We're trying to stimulate the vocal cords and the muscles at the back of the throat, so that can be with just plain water. But again, it can't be a little gurgly. It, you've gotta really kind of gargle like you mean it because we need to get enough movement of those muscles to get that stimulation. The gag reflex is also partly controlled by the vagus nerve. So again, That's where we're trying to use that as a branch to get up to the Vagus nerve, but that one's not really that much fun. So I include it because people may read about it. It is listed as one of the things you can do if you wanna do something for your throat. I would say sing or gargle first, it's gonna be just a lot more pleasant. Jill Brook: Right on. Dr. Kimberly Hindman: Yeah. Weighted blanket. So again, I looked through PubMed and studies on a weighted blanket. There were 300. This is something that people are [00:31:00] looking at and they are beneficial for anxiety, insomnia, reducing chronic pain. They've even been used to treat symptoms in late stage dementia. Like they're looking at all kinds of different things for these, and they think that it increases dopamine and serotonin and reduces cortisol. That's where the thought is, is that the compression and the weight has that direct impact on those neurotransmitters. Jill Brook: Hmm. Dr. Kimberly Hindman: We generally wanna weight of the blanket to be about 10% of the body. So we want you to feel safe, not trapped. So if you're doing this for a child, they always need to be able to get out from under the blanket on their own because if it's too heavy and they can't, then they will get really stressed. And because that's a stressful situation and we obviously don't want that. For some patients where a weighted blanket may get hot or it feels too much, try a bag of rice. Jill Brook: Oh. Dr. Kimberly Hindman: So it's smaller and then you can move it around, maybe put it under your belly, over your chest, over your back, wherever you want it. You can also try putting an ice pack underneath it to get both the cold and the weight. I don't really generally let [00:32:00] cold over the belly from a Chinese medicine perspective. We don't want that. We want that to be a warm place, but you could try it then, if you have like a rice bag or something that you put around the back of your neck, put an ice pack there and then put your rice bag over it, and then you're getting both the cold and the weight. And you leave it on for however long you want. Jill Brook: All right. Dr. Kimberly Hindman: So acetylcholine support. So acetylcholine is the neurotransmitter that's primarily used by the vagus nerve. So for some people, increasing the acetylcholine levels can help support the vagus nerve. This is one where I've seen, I'd say I, I've seen more mixed results. Some people, it really works great and some people it doesn't seem to do as much. I think in those patients it may be that we need more of the actual stimulation to the nerve. Not so much the neurotransmitter, but I think it's interesting. Symptoms of low or deficient acetylcholine include constipation, gastroparesis, memory problems, learning difficulties, dry mouth, dry eyes, orthostatic hypotension, low [00:33:00] muscle tone, depression, fast heart rate. Chronic inflammation, emotional issues. I'm thinking that sounds an awful lot like what a lot of people with POTS experience and deal with on a regular basis. Jill Brook: Yeah. Dr. Kimberly Hindman: So what I think is interesting is that normally the acetylcholine is made up of an acetal group and a choline group and the body hooks 'em together and there you go. That'll acetyl group is usually provided by something called acetyl coa, which is part of the cycle that the mitochondria used to make energy. But if you're remember back in that cell danger response, one of the first things that happen is the mitochondria stopped making energy. And that's to be protective so that say, a virus can't use that same machinery for their own uses. So what if the mitochondria aren't making energy, then where may not be enough acetyl groups? So that may be part of how those things get linked up, is that if there aren't enough acetyl groups around, then you don't make enough acetylcholine. And then over time, the vagus nerve stops function. So what I generally do is I [00:34:00] use acetyl L carnitine for the acetyl group, CDP choline for the choline group, and then pantadine, which is B five, which is the major cofactor for that enzyme. In doing so from the acetyl L carnitine, we also get the carnitine, which does help mitochondria. So if we've got mitochondria that just need to get going and they're ready for that kind of support, we get a little bit of that there as well. There are a bunch of different products out there that talk about being acetylcholine supports, and that's basically what they're doing is they're trying to stimulate that production. Jill Brook: Okay. Dr. Kimberly Hindman: So then I wanna talk about aromatherapy and aroma point therapy. So these are things that I absolutely love. So it's really interesting to me that unlike other senses, smell is different. So the olfactory nerve doesn't have to cross the blood brain barrier. So this means that the olfactory nerve, which is the nerve that basically comes to our nose, is the sense of smell, is actually an extension of the brain and has direct connection to the brain. So this may be part of why [00:35:00] smell is the sense that most strongly evokes memories. So if you remember, then the hippocampus is where we looking at like external stimuli and situations and pairs that with memory. Smell is one of the strongest ones. And people will say that like, Oh, I smelled something and I'm instantly remembered whatever that event was or whatever it was where I smelled that at first. So we can use that to our advantage. There is a whole class of scents that's called the euphoric, and it refers to the experience induced by the person rather than a characteristic of the fragrance. When you smell something that is your euphoric it creates this kind of bliss bubble is how one of my teachers called it, which I really liked. It just kind of smooths and soothes the energy. It makes you feel safe. Some of the examples are Jasmine, Rose. Lang Lang, neroli, sandalwood, caco, vanilla they can be really individual. My daughter loves clarins sage. It's one of the really rare ones, but she smells that, and I can see it on her face that she's just, Oh, [00:36:00] okay. Like, I just, I just feel better. I will say that if someone's gonna use something like that, try different ones. If somebody doesn't already know what things that make them happy, Try different ones. But make sure that whatever oil you're using is pure. We don't want any synthetics because that's all chemical and petroleum based. The ones that I use when I'm doing aroma point therapy, I get from monara.org. I have no connection to them at all, any ties of any kind. But I like them because they work with the suppliers. So if it says that it's Egyptian source, they've gone to Egypt and they've talked to the people, they know where it's coming from. They know how it's sourced, they know how it's being made and they know it's purity. And all of their oils then are pure enough to be used on the skin. So I know that then they would be safe for then someone to actually inhale and kind of breathe. And so that's something that you could use at any time. You could carry a little bottle around with you to just get a quick Ah, okay. You could use it as part of your meditation practice. To be part of that whole sensory connection. What we're trying to do though is use them then in times [00:37:00] when you can have a positive experience. So again, we get that direct input straight to the brain that says, Oh, this is good. Oh, I feel good now. Okay. And then we've shifted that neurologic state. Keep going. So Aroma point therapy is something that I do with patients, and I learned this from Tiffany Carroll, who's an amazing acupuncturist, has developed this and it's using essential oils instead of needles on acupuncture points. So I use it a lot with kids and people who just don't really like or have needle phobias. But what I like about it is the combinations are almost endless. because we have all these different oils and all these different points and different oils on different points, we'll give different experiences. So we can look at all different ways of working with them in terms of clearing trauma patterns, working it from like the Chinese elements perspective, looking at symptom patterns. We can do all kinds of different things. And I will say that I have seen patients change just from getting on my table, getting off my table with [00:38:00] this. So a great example. That I wanna share is that I had a patient who got off of my table after doing a treatment and she's like, I don't know where I am right now. She said, because I'm calm, but I have energy. So the only times I have energy I'm panicked and full of anxiety. And when I'm calm, I'm exhausted. So I don't know where I am right now. And I said, I think you're in the Vental Vagus site now. And she's like, This is beautiful. I love this. So I just wanted to share that, to let people know that sometimes you can have really big shifts pretty quick. Jill Brook: And that's just trial and error of different aromas that you enjoy at different points. Dr. Kimberly Hindman: right? And you can just smell them. So if you can find somebody who does this therapy near you, that's great. Give it a try. If you just wanna use them yourself and trust your own intuition. So if you have a feeling that I wanna put this on me somewhere, go. So if you feel like I really need this over my heart, great. If you want something on the bottoms of your feet, great. Keep it away from eyes and mucus membranes. [00:39:00] But other than that, you go with what works for you. And I would say in general, for all of these pain people may need to try different things to see what works best for them. So there may be things that work best for certain symptom. Or certain triggers or certain situations, and I want people to have a toolkit that then they can pull from and find things that work from them. If you're in a place where obviously you can't do much, you may have some limitations, I don't know that rocking back and forth in the middle of a meeting at work is gonna necessarily be the best thing. You wanna sit and do that in your car at a stoplight. That's another one that you. . So there's all kinds of different things that you can do here. There are also things called external vagal nerve stimulators. And there are some instructions about how to make kind of a DIY one from a TENS unit. And I have those in my handouts that I have on my website if people wanna check those out as well. I've only had a few people, actually a handful probably, who try the external stimulators and they've had variable results. I would say try some of these other things first, because some of these stimulators can be pricey. if some of [00:40:00] these other things work and cold water is basically coming out of your tap already, then use that. So I wanted to then just go through the couple of Dr. Rosenberg exercises. So people have these as well, and they're really effective. I have done these and truly been amazed at times, the atlas, which is C1 on the axis, which is c2, and the entire spine increase the blood flow to the brain stem to have a positive effect on then the vagus nerve and some of the other cranial. He talks about trying to do how different I feel after just a short period of time. So the first one is called the basic exercise. And he says the goal is to reposition some rotation, like right and left beforehand, just to see kind of what your range of motion is and you can use that to see then afterwards if there's any changes. But the instructions are super simple. lie comfortably on your back and weave your fingers together and then put that behind the back of your head. And so you're just kind of resting the weight of your head in your interwoven fingers. You just really wanna[00:41:00] let your head just kind of rest back. If you can only do that with one hand because of a shoulder issue or something, that's totally fine. I have also tried doing this sitting up when I need to do something just for myself in this moment, and it's worked too, so I don't even know that absolutely. Laying down is necessary. And so then keeping your head in place, you just kind of use your hands to hold your head in place. Look to the right moving only your eyes. Only as far as you comfortably can. We're not trying to put strain on your eyes. It's just go to the right and don't turn your head. So we're using eye movements to stimulate the vagus nerve, and then after a short period of time, usually 30 to 60 seconds, sometimes even shorter than that, you will swallow, yawn or sigh, and that's a sign of the relaxation in your autonomic nervous system. Jill Brook: Are you holding your eyes to the right that whole time? Dr. Kimberly Hindman: So you hold them there until you yawn, swallow, sigh, and that usually will take 30 to 60 seconds. And then you bring your eyes back looking straight, and then [00:42:00] leaving everything in place. Then you do it to the left, or you can do left first and then right, doesn't matter. And then again, same thing. Hold them to the left for that 30 to 60 seconds until you get a sigh, yawn, or a swallow, and that's it. So the whole thing might take you two minutes. Jill Brook: Wow. Dr. Kimberly Hindman: And that's it. Yeah. So that's the first one. Jill Brook: Sounds like a perfect thing to do while you're lying. Trying to fall asleep at night. Dr. Kimberly Hindman: That's one of the times that I make sure that I do it on a regular basis. Exactly. So the next one. It's called the salamander exercise, and he has one that's called a half salamander and a full salamander. So the half one is talking about increasing flexibility in the spine, moving, you know, increasing movement between the individual ribs and the sternum to increase your breathing capacity and then reducing scoliosis and that head forward posture. So with this, you sit or stand in a comfortable position, and again, without turning your head, let your eyes look to the right. And then continuing to face forward, you tilt your head to the right so that your right ear is moving closer to your right shoulder. [00:43:00] But keep your shoulder down. You're moving your head, not raising your shoulder to meet your ear. Keep your shoulder where it is and let your ear drop. And then you're gonna hold your head in that position. So keep your eyes looking to the right and your head tips to the right. So it's a little bit like more advanced from the basic exercise. And we're gonna do the same thing, 30 to 60 seconds until you get that yawn, swallow or sigh. Then come back to neutral, look forward and then do the same thing. Move your eyes to the left, and then do a side bend of your head to the left. There's a variation that he talks about in there, which you can let your eyes look to the right, but tip your head to the left, so you're doing opposite and then the same thing. Look your eyes to the left while tipping your head to the right. People can see then how that feels if they like one versus the other more. The full salamander is basically an extension of that, so you're actually on all fours and you want your head and your spine to be [00:44:00] level. So you wanna make sure that you're not arching or bending your back too much. And the same thing, you're gonna look to the right, tip your head to the right, and then you let that motion basically keep going so that your whole body then is basically tipping them to the right. So you basically let that curve basically go down your spine. For some people that feels like it's too much and they just like this, the smaller one. But I wanted to let people know that you've got that option, that if you feel like you actually want even more. You can get that motion going all the way down your spine. And then it's the same thing with the other exercises. Come back to neutral and then do the same thing. Look to the left, tip your head to the left, and then keep turning your body so that you bit that curve going all the way to the left. Jill Brook: You just do it long enough until you sigh or yawn Dr. Kimberly Hindman: or swallow. And usually it's a big swallow. If I have done it for 60 seconds and I haven't really noticed anything, I go to the other side. It's interesting that sometimes I find for myself [00:45:00] doing things to the right, I get a much faster response than doing things to the left. So I'm not sure if, for me, there is some difference between the right side and the left side. I will say then that like before I had my tethered cord surgery, all my symptoms were on the right. So I am a very sided person in terms of like my joints on the right side are also give me more trouble than on the left side. So I'm a very right-sided person and I think it's curious then that when I do these exercises I can sometimes look to the right and within 10 seconds I'm yawning and then I go to the left and it might take me a full 60. Sometimes it doesn't, like I don't ever get. anything Jill Brook: And is the yawning or the sighing or the swallowing a sign that you have kind of gotten more of a parasympathetic state going. Dr. Kimberly Hindman: Yes. That tells us that we have gotten that stimulation to the vagus nerve. And that's then what is causing yawn, The changing in the breathing or the swallowing, because that the vagus nerve controls all of those things. So remember, it controls swallowing, it [00:46:00] controls breathing, so it's controlling all of those things. So when those happen, it tells us, Oh, it's just done something. It's active now. So I wanted to kind of close this one up with like, how do we know if any of this stuff is working? So giving you all these ideas, all these things to try, how do I know that any of this is doing anything? And what I have found is there are some things that we can keep track of that tell us. So if somebody finds that they are in that ventral Vagus state more often as their baseline. So they just kind of check in and they go, Oh, I'm calm, but I have energy. Huh. Okay. So we're not in sympathetic, we're not in shutdown. Our only other option is that parasympathetic. So if you just check in and kind of feel, Oh, Where am I in here? Or is, More often than not, I'm saying, Oh. And that's where I'm at. Over time, if it takes a bigger and bigger stimulus to kick somebody out of that ventral Vagus state. So if that's your baseline and it used to take a small trigger, does now it take a bigger trigger, [00:47:00] That's an indication that you've got more reserve. You're spending more time in that Vental Vagus that's gotten stronger. That's where your body wants to be. We don't want you to stay there always for forever. We have these other branches of the nervous system for a reason. They're, important. So you may need to kick into sympathetic for whatever reason we just wanna get you back again. So one of the third things that I see is that if somebody gets out of that vental vagus, that parasympathetic, their response may be smaller. So maybe somebody feels a little revved up rather than a full panic attack, or they feel like a little checked out, I need to rest rather than going into full shutdown. The fourth thing is the process then of getting into that sympathetic or dorsal Vagus becomes slower, and I think that's a really, really big one because it takes a longer time. This allows somebody to recognize what's happening and use some of these tools in real time to disrupt the process. It's really difficult to do anything for yourself. If you go to like zero to 60 in a millisecond. All you know is I'm already here and I have to [00:48:00] try and wind this back. If you can give this sense of, Ooh, I can feel where my nervous system is going. You can say, No, no, no. Come on back. We're gonna do one of these other things. And you find that over time the nervous system gets retrained. Oh, oh, okay. I'll come back where you want me to go? And so then the last thing that I look for is, is it taking less activity or less time to get back to that ventral state, ventral Vagus state? So it's easier to get. It's taking a bigger trigger. My responses are generally smaller. It's taking me longer to even get to that response and I'm getting back faster so that I'm spending more time in this state. So people may find different ones of those they notice first. But those are some of the things that people can look for and say, Oh, okay, I think that's working for me. so that's what we've got for a vagus nerve. And next time we'll talk about limbic stuff. It kind of ties in. But there are whole other things about limbic system retraining, so that's a whole other topic. Jill Brook: Excellent. So this is so [00:49:00] many concrete, cheap, easy available things so we can all be doing a lot of these things. And what goes through my head is there's nothing to lose, right? I know that I definitely spend not enough time in the proper vagal tone. And so I'm gonna be doing these big time and I'm thinking about how I'm gonna sing every chance I get. I think I'm gonna gargle. I gargle every time I brush my teeth. So now I'll do it hard and loud. In the cars, a lot of things. I love that now we can justify as much laughter as we can get. I love the idea of kind of thinking loving thoughts or doing the love bubble doing dishes. And it feels like all those moments throughout the day when normally I would be kind of reved up or hyped up. Now there's almost always something productive that I can be doing about it instead. So I definitely plan to do this. Do you have any favorites [00:50:00] that either for you or your patients or it's just everybody has to try different things. Dr. Kimberly Hindman: Everybody's really different and that's why I will like give people a handout that has like all of these things on there and tell people, try 'em. I have some patients who absolutely love rocking. I have one patient who just loves it and she sit and she'll rock and she'll do some joint rotations while she's rocking and she's like, It just feels so good. She's like, I just feel so comforted and relaxed and safe and just and that has been the biggest thing for her. I do find sometimes when I'm really stressed, sometimes I will catch myself at my desk just rocking a little bit and I think, Oh, okay, my nervous system is telling me I need a little help and I'm just gonna go there. I'm just not even gonna tell you. I'm just gonna go there. Jill Brook: That's handy, Dr. Kimberly Hindman: is really nice. Cause there are times like, oh, I need to do some more for myself. And these are things that anybody could do, kids can do them. I mean, it's so many of these things. You don't need to buy anything, go anywhere, do anything. You can do them laying down. If somebody's really having a tough day, you don't have to [00:51:00] then like go be physically active to be able to do anything. I would love it if your listeners then could give some feedback to you or to me about some of these things and what has worked for them, or if they find other things that seem to have that same effect. I would love to be able to keep expanding this to just have more and more ideas, because there may be things that aren't on that list, but as people try them, they go, Oh, that gives me the same feeling as those other things. I think that maybe doing the same thing, that would be fantastic. Jill Brook: Absolutely. So hey listeners, you can email anything like that to [email protected] and we will be excited to hear it and what I'm hearing from you is really what you wanna achieve is that feeling of safety, of love, of comfort, and how you get there is not so important. Dr. Kimberly Hindman: Exactly. However you get there from these ideas is great. And I think that, you know, for people say, Sometimes people will use things [00:52:00] like a drink to get there. And yes, that can create a sense of relaxation. It doesn't always create a sense of safety, and that's different. And over time, that's not gonna be really a great health tool. We don't want somebody being relying on alcohol as the thing that helps them. And again, that relaxation is not necessarily the same thing. We wanna get that sense of I feel good in my body, I feel safe. I just feel like in this moment all is right within me. Jill Brook: Beautiful. Absolutely beautiful. Anything else to say about the vagus nerve or these Dr. Kimberly Hindman: I don't think so at this point. I would really love to hear back from people because these things really do work. You do have to give it a little bit of time, depending upon how dysfunctional things have gotten, because again, it's like we're retraining that dog that's been barking at everything. What do we want? We can't just do one session and have it all be good. So keep at it. Keep trying to keep trying different things. If you try something that doesn't work, try something else [00:53:00] because I've seen these things really work for people. and that's gonna be beneficial, not just for POTS. It's gonna be beneficial for all sorts of symptoms and how you feel and how you live your life, how you go through your day. It's gonna be better for then how you feel about you. And that ultimately I think is really a good thing. Jill Brook: All right, listeners, let's get to it. Dr. Hindman, thank you so much for all of this thorough and practical information. I know you have spent so much time scouring the literature for these strategies and that you really work hard to find things that are safe and easy and accessible to all of us, and we are just so grateful for your taking the time to do this. Dr. Kimberly Hindman: My pleasure. I'm so excited to hear back from people about what they experience and hopefully they've had good experiences with these things. Jill Brook: Yeah, so listeners, you can again write any experiences you have to [email protected]. That's all for today. We hope you enjoyed today's conversation. We'll be back next week, and until [00:54:00] then, thank you for listening. Remember, you're not alone. Please join us again soon and I'm sending you all some of that love bubble. Okay, bye-bye.