Episode 224: Vagus Nerve Stimulation and Inflammaging w/ Dr. Kevin J. Tracey

In this episode of The Aging Well Podcast, Dr. Jeff Armstrong is joined by Dr. Kevin J. Tracey, a renowned pioneer in bioelectronic medicine and President and CEO of the Feinstein Institutes for Medical Research. Dr. Tracey discusses groundbreaking insights into inflammation, chronic low grade inflammation, and aging. Learn how vagus nerve stimulation could potentially reduce inflammaging, prevent disease, and revolutionize healthy aging. Dr. Tracey also shares his personal journey into bioelectronic medicine and explains the science behind vagus nerve stimulation and its potential advantages over traditional pharmacological approaches. Tune in to understand the exciting future of bioelectronic medicine and how it might transform disease prevention and aging in the next decade.

TruDiagnostic epigenetic testing
Get a 12% discount using promo code (AGEWELL) and track your pace of aging well.

Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.

Have questions you want answered and topics you want discussed on the Aging Well Podcast? Send us an email at agingwell.podcast@gmail.com or record your question for us to use in an upcoming episode:
https://www.speakpipe.com/AgingWellPodcast

Transcript

0:00

On this episode of the Aging Network Podcast, we explore the cutting edge science behind inflammation, chronic low grade inflammation, and aging and age related diseases. Joining us is Dr. Kevin J. Tracy. A pioneer in bioelectric medicine and president of the Feinstein Institutes for Medical Research, Dr. Tracy shares groundbreaking insights into how vagus nerve stimulation could revolutionize the approach to healthy aging, potentially reducing inflammaging, preventing disease, and redefining what it means to age gracefully. If you've ever wondered how to extend your healthy lifespan without relying on medications, this is the episode for you. Welcome to the Aging Well podcast. Let's just start by having you tell us a little bit about yourself and how you became interested in bioelectric medicine. Well, thanks for having me on, Jeff. It's great to be here. I am a neurosurgeon who has been studying inflammation for going on 40 years. And the reason for that may not be obvious, But in retrospect, it makes sense throughout my career. I always wanted to do science, to run a lab do and do research pursuing scientific mechanisms that we could turn into new therapies. And in the course of training to be a neurosurgeon I took care of a patient who was only 11 months old, but she died in my arms of overwhelming inflammation. And so that, captivated my scientific interest a long time ago, 1985 that drove the rest of my career. As a neurosurgeon, I spent a lot of time looking at people's reflexes and to make a 40 year story very short The convergence of those, of that interest in inflammation and the fascination with re, reflexes was probably one of the factors that allowed my colleagues and I to discover what we now call the inflammatory reflex and the vagus nerve. So what exactly is inflammatory aging and why is it such a critical factor in the aging process? Well, the flavus The aging process is complex and it's not completely or maybe at best partially understood in terms of what drives it, what causes it, and what can we do to slow it down. There's obviously a great amount of interest in looking at ways to slow down aging which means there's a lot of interest in understanding what causes it, but there's no consensus on what are the main mechanisms that cause aging. what we would ascribe to be the aging problem. There's genetic factors that are being studied. There's oxidative energy, metabolic factors that are being studied. And the list is long, but one of the things that has been implicated by many studies as either causing the damage in the tissues of aging, or at least contributing to it is inflammation. And it's such a consistent finding. In in the aging population that the burden of inflammation in the tissues increases that the, and we know that inflammation causes pain. Inflammation causes tissue damage. Inflammation causes the things that people complain about as they age. So the obvious question is inflammation and aging, are they linked? Are they inseparable? And hence the, this relatively new word only coined a few years back inflammaging to speak. to bring those two things together. And there's a lot of work on that. And there's a lot of work being done and there's a lot of interesting results, but it's not black and white. It's not crystal clear yet. So can you share some key diseases or conditions that are linked to inflammation? If you look at how many people on earth die every year, there's about 60 million people, give or take that die every year on the planet earth, about 40 million of them. Die of diseases that are either caused by or made worse by or in which inflammation is a contributing event. So things like heart disease and stroke, cancer. Neurodegeneration, Alzheimer's and Parkinson's disease, that kind of thing. Metabolic conditions like obesity, metabolic syndrome even diabetes and hypertension. These are major factors in the deaths of 40 million people on the planet Earth every year. They tend to increase with aging. And they, they all have at their basic molecular mechanistic level evidence that inflammation can make those conditions worse, sometimes cause those conditions and is therefore a contributing factor. So the open question is, if we could eliminate the contribution of inflammation to those conditions, if we could eliminate the contribution of inflammation to shortening what we can call health span, then the question is would we live longer? Would we not die of those conditions? Thanks. And would we would we have a longer health span? Will we? feel better longer in our lifespan. So what is the vagus nerve? And I know this, but maybe our listeners and viewers don't, but what is the vagus nerve and why does it play such a crucial role in reducing inflammation? The vagus nerve is one of the major information highways connecting your brain to your to the organs in your body. It is we say, we call it the vagus nerve, but it's like saying the thumb the vagus nerve is a paired structure. You have two thumbs, you have two vagus nerves, one on each side. Even that's an oversimplification because in each of those two vagus nerves one on the left and one on the right, traveling from your brain about the level of your ears through your neck, down your chest into your abdomen. But for each of those, in the neck anyways, in humans, there's about a hundred thousand fibers on each side. So you, you really have to be careful when you say the vagus nerve. We know everyone knows what you mean when you say that. But if you start to talk about specific functions of the vagus nerve, then the question becomes, well, you have 200, 000 vagus nerve fibers. So which ones are we talking about? Where do they go and what do they do? The simple answer is the information traveling up and down from the body to the brain. brain back to the body in these 200, 000 vagus nerve fibers is critically important to controlling the function of organs like that you don't think about or are not aware of or can't feel how fast your heart is beating, how high or how low your blood pressure is, how fast you're digesting your food and how much urine you're making. All of these things are influenced by the Electrical signals are the neural signals traveling up and down in the vagus nerve. So, so it's embedded in, it's embedded in your, in the part of your body brain access that we call autonomic not automatic, but autonomic as in self governing autonomy, it's the part of the nervous system that you can't consciously think about to control. Yeah. And teaching exercise physiology. Probably have. Too much of a tendency to just link it to the heart as we talk about, you know, the regular regulation of the heart rhythm But it is fascinating how much the vagus nerve really contributes to the overall Regulation of kind of resting conditions in the body. So how does vagus nerve stimulation work and What makes it such an effective tool for? So, the idea of using vagus nerve intervention or vagus nerve stimulation to treat inflammation came from an accidental discovery, an unexpected discovery in my lab back in the late 1990s. And what we discovered is that if we accelerated the signals in the vagus nerve with a hand held device, nerve stimulator in various animal models, first in mice and rats, later in dogs and people. We found that the increasing the activity of the vagus nerve with electrical pulses turned off inflammation by a whole number of different measures. And because we could turn off inflammation using vagus nerve stimulation, we showed it was possible to do this first in, in laboratory models of arthritis and colitis and even sepsis. And that led that, that led my colleagues and I to start a company called Set Point Medical, which we spun out of the Feinstein Institutes at Northwell Health in New York. And that company recently announced after what, almost 17 years of work Recently, just a few weeks ago, announced that the success, the successful results of a clinical trial implanting a miniaturized vagus nerve stimulator which is they call an immune neuromodulator, which is about the size of a vitamin capsule and implanted on the vagus nerve, a patients with rheumatoid arthritis. And the clinical results reached all the primary endpoints of the study, which means that. There's now statistically significant evidence from some 240 patients or more that the vagus nerve stimulator was able to give significant clinical benefit, even in patients who were not benefiting from very powerful very powerful drugs. And so what this means is we're on the threshold potentially of a new era when specifically Neuromodulating devices and other modalities. to control the activity in the nervous system may hold the key to controlling the activity in the immune system that, that causes inflammation and causes inflammation. So, so this is a very exciting time for these stories. There's a lot of questions but we do know that this can be done safely. And it, and in, and now in this first large clinical study done in 40 centers around the United States it, it appears to be effective. So time will tell what comes next, but I fully expect that this approach will be applied in short order to a lot more a lot more conditions potentially multiple sclerosis, inflammatory bowel disease, lupus and the list is long. So time will tell. And I think the answer seems pretty obvious to me, but maybe it's not as obvious to our listeners and viewers. What advantages does vagus nerve stimulation have over traditional pharmacological approaches? The answer to that question is incredibly important for patients particularly who like in this current study I just mentioned from Setpoint, the study is called Reset RA. These patients were out of options. These patients have been on the most powerful drugs that you see advertised on TV with some regularity. These drugs are given by injections. Many of them, they're called biologics. Many of these have to be injected. So they're invasive. Many of these drugs have black box warnings. Which means, because of the immunosuppression that these drugs cause patients run the risk of secondary infections and other complications. These drugs are very expensive. Some of them cost 100, 000 per year for life. And it's not uncommon for the expense of these drugs to cause people to have to choose between their financial security and their ability to be treated for their underlying conditions. So, so these drugs have helped millions of people. I had a hand in my early part of my career in helping to define the utility of this approach to use biologics. So, we have to recognize that the importance of these drugs and the pharmacopeia. But your question was, what advantages would vagus nerve stimulation offer? And the answer is, we have decades of experience using vagus nerve stimulation to treat other conditions like epilepsy, and there's no evidence of immunosuppression. Like you have with the biologics. The pricing hasn't been set yet. The clinical study that was recently reported has not yet led to FDA approval. I hope that happens. I don't know if that will happen. This, the, This device is undergoing FDA review now, but so the price, the pricing of it hasn't been set. But if it's like other medical devices, it would be more like a one time cost for implanting the device rather than an annual recurring cost year over year. And the open question will be risk and benefit long term. You know, when you look at these patients in this first study, they were out of options, many of them, So, when you think about risk and benefit of a new device that has to be implanted surgically versus continuing on drugs that have black box warnings, which are having limited or no effect, you have to add in, you have to add in the risk benefit equation, the risk of continuing to suffer from the illness versus the risk of a surgery and a new device. Now the surgical procedure. is very straightforward. It's not a long procedure and it's done as an outpatient. In other words, you come in the morning and you go home in the afternoon. You don't stay overnight in the hospital. For most, obviously, you could have complicated patients or cases, but the expectation would be that the vast majority of these patients will be in and out same day. So, there's a lot that still has to be done but You know, the good news is there's a tremendous interest in this on behalf of patient communities. There's a tremendous interest in this in the scientific community. I mean, the science that I summarized in about, what, 25 or 30 seconds, maybe 40 is based on decades of work by not just my lab, but by hundreds of labs, published in thousands of publications. So we understand how it works and the question now is, What do we have to learn further to understand how to best use it in patients? And that's not a trivial, that's not a trivial question but I think what's going to happen is patients are going to want to try this and I think that's going to accelerate the process. Now, if I understand correctly, the handheld is currently available, but we're still kind of waiting on final approval for the implant Implantation if I can spit that out Of the stimulators, is that correct? Well, it's correct that you are repeating. What's been promised put out in millions of web impressions but those web impressions are not correct. There, there is no handheld, there is no handheld Vegas nerve stimulator. There's what's been approved so far are handheld devices that are called Vegas nerve stimulators, but there's no scientific evidence that putting an electrical device on the skin of your neck or your ear is directly stimulating the Vegas nerve. We just don't know that. What we know is that if you're going to stimulate the vagus nerve in a way in which you know, the vagus nerve is being stimulated. Then you have, you can do it two ways. One is what we've been talking about. Put a device on the vagus nerve. And obviously the most accessible place to do that is in the neck, right, right next to your, the pulse that you feel near your Adam's apple, your vagus nerve is right there. It's between your Adam's apple and the pulse in your neck. So it's very possible to do that. And we know that, We're stimulating the vagus nerve when we put the device and attach it to the vagus nerve. The other way to do it is with focused ultrasound. And this is a method of ultrasound. It's very similar to the ultrasound that is used to visualize fetuses in the womb and gallstones and kidney stones, same kind of ultrasound, but there's a different lens on it and a different power setting. And when you focus the ultrasound activity on a nerve, you like the vagus nerve, you can activate that nerve. So you can stimulate it through the skin directly and you know that you're stimulating it. The other methods are essentially transcutaneous electrical methods, very similar to TENS units. And they put a small amount of current directly onto the skin in the hopes that the current would travel through the skin of the neck, through the platysma muscle, through all the layers of fascia, through the carotid sheath and into the vagus nerve. However, biomedical engineers who've looked at this very carefully and, in, in many different animal models, and in other physiological conditions, can't find a way for a very small amount of current that you can put on the skin. Without having pain it's not enough current to target the vagus nerve specifically. That being said, the current from a TENS unit could go in your sensory nerves up to your spinal cord or brain stem and into your brain. And once those incoming signals arrive in your brain could send signals out the vagus nerve or a lot of other ways. Down the spinal cord, out the sympathetic chain. So, the point is you can apply electrodes to the skin of the ear or the neck and hope you're stimulating the vagus nerve. But to call that a vagus nerve stimulator is not scientifically correct. Meaningful, frankly, I mean, I have a certain level of vision of how Vegas nerve stimulation can have an effect on people like myself. They probably have low levels of inflammation, not a disease type of inflammation, just The effects of aging exercise and all those types of things that doesn't seem to be really on the horizon It seems like this is much more something that will have the greatest benefit for people who have really chronic Inflammatory conditions is that correct? I think the simple answer is yes I think that's I think you're gonna have to I think you're going to have to look at the fact that this is a new technology. As I said, SetPoint developed this over the last 17 years. It's the size of a multivitamin and it requires surgery. So there's going to be a lot of work to do in thousands of patients. And in order to justify that, you're going to have to, you have to have a risk benefit ratio where You have patients with serious conditions who are going to derive significant benefits. So that'll be rheumatoid arthritis first, and like I said maybe soon to follow additional clinical trials. You bring up another point, which I think is, again it's all over the social media and the internet millions, if not billions of web impressions about the importance of inflammation and in exercise responses and day to day life and aging. Frankly we have to be careful because we probably need, we're probably bumping up against a semantic challenge. We probably need to think really carefully about definitions of what we mean because we use inflammation to describe pretty much everything. When in fact, you know, the way inflammation was defined by the ancient Greek physicians, Was the presence of rubor, calor, dolor, and tumor redness, heat, swelling and pain, which is which occurs in the presence of an infection or occurs in the presence of an injury. So, okay, that's, you know, you sprain your ankle You tear your ACL, you have a sports injury, or you get an infected pimple. We also we know these things, that's inflammation. But when you dive a little deeper and you look at the brain of a patient with Alzheimer's disease, or the heart of a patient with atherosclerosis and heart disease, you don't see redness, pain, and swelling necessarily. You know, you don't see heat necessarily. What using, You know, obviously, laboratory, sophisticated laboratory methods and techniques, technologies. What are some, you see the same molecules. So, if you look at the molecules in the infected mosquito bite, and you look at some of the molecules in the brain of the Alzheimer patients they're there. They're in both places. And sometimes you see, if you look at the cells that appear, sometimes the cells are the same, but sometimes they're different. And you don't see the same kind of cells in the brain of an Alzheimer's patient or the artery of a heart disease patient. You don't see the same kind of cells as you see in the infected mosquito bite or the torn ACL. So it's different, but we call them all inflammation. And, you know, it's good to a point. I think what's good about that is it's called tremendous attention to inflammation. And this idea of linking the nervous system to the immune system to control inflammation is one of the, one of the hottest areas, potentially the hottest area in all of science now, called neuroimmunology. It's an incredibly exciting field that when I talk to young people in the sciences, they all want to, seem to want to go into it. So, so that's good but I think there's a tremendous opportunity. I like the word inflammation not because we understand it, But because it speaks to this point that we need new semantics. And it goes back just to the I use the analogy of the heart disease patient and the Alzheimer's patient. I use those analogies because those are two of the conditions of aging associated with aging. In which, you know, inflammation may contribute the molecules or the there's a lot of overlap between the molecules but is it really inflammation? No, it's not the same as when you tear your ACL after a workout. So, so will Vegas nerve stimulation be used in everybody for all conditions? No, it's not going to, it's not going to work in everybody. It's not going to help every arthritis patient. It's not going to help every Alzheimer's or heart attack patient. It's not going to happen. It. help every athlete recovering from an injury or a workout, but it may help some. And that's the research opportunity we have now. And that's a tremendous opportunity. So I think it sounds like vagus nerve health is a very important aspect here. So are there simple ways? People can support their vagus nerve health without any kind of medical interventions? There are, and again, caution from getting all your medical advice from social media and the internet is warranted. I think you preach the same thing on your podcast, and I applaud you for that. Caution is warranted. If you have a serious medical condition, before you do anything, you should check with your physician. I mean, it's important. It's obvious. But people have to hear it. We all have to hear it. But that being said, it's amazing to me that the things that have been linked to Quote unquote increasing or improving vagal tone as it's called and we could talk about what that is Are the things that people that you and your physicians? Tell everybody they should do you should eat a balanced diet maintain your gut microbiome you should exercise with some regularity cardiovascular exercise, you know, if you're a lot, if your physician allows that and try to maintain your VO2 max to the point where your resting heart rate is slower rather than faster you probably, you want to avoid or manage stress in your life, whether it's through meditation or other relaxation therapies, that's a good thing and you want to get enough sleep, all of those things. Which are, you know, to some audiences boring and old fashioned. Those are the things that for which we have reasonable evidence that help, if you want to call it support the vagus nerve or stimulate the vagus nerve. You get into really complex discussions when you try to dive in for the, for how these things work and for the proof that they work in good physiological studies or good randomized controls clinical trials. And we could talk about that, but the simple answer is those tried and true things all do. Support vagal tone to a reasonable extent. So what are the next steps in research for the vagus nerve stimulation particularly in the context of aging? Can you, I'm sorry, can you please repeat that? Sure. What are the next steps in research for the vagus nerve stimulation, particularly in the context of aging? I think in the context of aging there's a lot of work to be done in, in, in laboratory experiments and animal models and in In clinical trials, but I think before we get to clinical trials for aging, we're really going to have to understand better. What is it? We're what is it? We're trying to do what? How do we measure? Inflammation, for instance, is a good starting point. So if you have if you go to your annual physical, you know, if you're over 50 anyways, your physician, you your physician is probably going to do a hemoglobin A1C test. Hemoglobin A1C is a way to get a blood test that reflects how high your average glucose levels have been over many days or weeks prior to that test. And the reason for that is at any, you could have diabetes or some other condition where you have chronically elevated glucose and a high hemoglobin A1C, but at any given minute on any given day, your glucose could be low. So in order to control for that, the hemoglobin A1C test sort of summarizes, so, so in order to control for this variability in glucose, the hemoglobin A1C test was invented or discovered and developed As a way to sort of summarize your total glucose burden or over many days or weeks. We don't have that for inflammation, but it's a similar problem. You could have s serious chronic inflammatory conditions, but on any given day or any given minute of. blood test of your of your cytokine levels of your, of other markers of inflammation that we use in the laboratory, they could be completely normal or even low. We don't have a hemoglobin A1C for inflammation. Some people look at C reactive protein, CRP. And there's some, and there's some pros and cons to using that. Some people look at IL 6, a cytokine that may be somewhat like hemoglobin A1c, but they're not perfect. And we don't know yet how to best apply those to long term studies, which is what you'd have to do in the aging population. So there's a lot of work, basic work to do before we could recommend, if you will stimulating the vagus nerve as a treatment anyways in the aging population. But when you look at the clinical evidence, there's some powerful clinical evidence that No matter what your age is the higher your vagal tone, the slower your resting heart rate the better the odds are for living a longer, healthier life. And this has been looked at in the Framingham study in, in an enormous French study that traveled, that tracked people for decades. And we can say that, as a rule of thumb, The populations with the lower resting heart rates have a have a longer lifespan relative to patients. populations with higher resting heart rates. So, so does that mean if you check your pulse right now and it's 102 that, that your goose is cooked? No, of course not. Patients can live to be a hundred with very high heart rates for very many years. But looking at a population basis, it, the things that slow your heart rate, exercise, balanced diet, getting enough sleep. Those things all do increase vagal tone, which some people call increasing vagal tone similar to stimulating your vagus nerve. So there's a lot to do, but there's a lot of good reasons to do it. Yeah, this is all fascinating stuff for me because, you know, my PhD, I studied under Michael Flynn, who has done a lot of research in exercise immunology and he actually coined the term influx. It's a hardest, one of the hardest phrases to ever say. It's inflam, inflam, inactivity. You know, so that, you know, a lot of this inflammation we're seeing with aging goes back to some of the things you just talked about with the vagus nerve that are going to help it with, you know, good diet, good sleep. Plenty of physical activity and exercise and all those types of things that we on the podcast kind of preaches are six pillars. Those all contribute to kind of a healthier vagus nerve. So how do you envision this technology changing the way that we think about aging and disease prevention in the next decade? I think what's changing is the appreciation that we are living longer and that as we live longer It becomes more important, more and more important for people to live healthy longer. And that's the trade off right now is we're living longer, but many people sadly are spending the last 10 or more years of their life, either in chronic pain or in chronic disability from either diseases of either of their brain or their heart or other kidneys or other organs. The question is if we could If we understood that these conditions were accelerated by, being made worse by, or even caused by too much inflammation, what could we do about it? Well, first of all, we have to, like I said earlier, you and I were talking, first we have to agree on definitions, you know, are there inflammatory molecules or inflammation mechanisms that we can target? with either drugs and now potentially with vagus nerve stimulating devices. If we target those mechanisms in an aging population, what happens? Well, we can't just run in and start doing that. We have to learn more first in laboratory studies so that we can build a scientific case. around doing that. But do I think it's possible that this will happen someday? Yes, I think it's possible that someday we will be thinking about targeting inflammation with neuromodulating devices in populations to prevent future complications of low grade background inflammation. It's not time to do that yet. We need to learn more, but yes, I think it's possible. Well, as I look at you and you've thrown out a few time points. In your career at me in the 80s and 90s. I'm guessing that you are older than you look. So what are you doing personally to age well? I don't know if I'm aging well or not. But I actually do many of the things we've talked about, Jeff, because I believe not only the data from my own lab, you know, Sangeeta Shivan and I run a lab at the Feinstein Institute and we work on these things every day with 20 of our colleagues. But much of what we've talked about and what Sangeeta and I have found and studied, much of that has been either replicated in other labs around the world or independently discovered in dozens or hundreds of labs around the world. So the things I do are based on what I've, what I what I've learned. So I do exercise regularly. I do. meditate. I do try to get enough sleep and I do try to eat a balanced diet. I also do several days a week do finish my shower by turning the water on full cold. And I do that because there's reasonable evidence that this actually stimulates at first when that when you step in that cold water or your ice bath if you have one. The first thing that happens is a fight or flight response. It's a massive sympathetic discharge. And the evidence for this is overwhelming. It's been studied in, in many very good physiology departments and laboratories around the world. So this massive fight or flight response is is anti inflammatory. It turns off The white blood cells in the bloodstream, and I think that's a good thing. Once in a while you want to turn those white blood cells off, and let the whole system calm down. Now, if you stay in the cold water long enough, and this really depends on your own personal physiology, And, or if you have the cold water on your face for a period of time while you hold your breath. These things over time, after this massive fight or flight response passes what happens next is that you are in fact stimulating your vagus nerve. And your heart rate will slow. And extreme cold for extended period of time and again, this depends on the individual and on their cardiovascular fitness, but will lower your heart rate. That is, that means you've stimulated your vagus nerve. So, these things are interesting to, I call it on myself, self experimentation. And I can't recommend it to your whole audience. They should check with their physician. If you do breath work to stimulate your vagus nerve, please do it lying safely on a gym mat, not in a chair. Driving a vehicle or operating machinery or in water. Because dangerous things can happen from that. But the these things do stimulate your vagus nerve in, in many people. And whether stimulating the vagus nerve with these natural modalities is controlling inflammation in people, we're not sure. I think it might be. So that's why I do it. There is so much exciting research on the horizon. Yeah. with this stuff that just fascinates me and I get really just kind of stoked to hear it. So for, sorry, Jeff, we're living in a tremendously exciting time and we're living in a tremendously good news period for science and medicine. And you know, for all the problems and all the bad news the rate of scientific discoveries that's coming out. Every week or month is mind boggling. And if you put it in the context of history it wasn't long ago when 80 percent of the people, at the turn of the last century, 80 percent of the people who died in Boston Massachusetts, where they had decent death records. 80 percent of them died of a complication of infection. Now that number, even after COVID is a fraction of that. Most of the deaths, as I said before, two thirds of the deaths on the planet earth are not caused by infection. They're caused by inflammation. So what I dream about when I think about the future is what if we cured inflammation? We haven't yet, but what if we did? Would we add another 10, 20 years to lifespan? I think we would definitely add another 10 or 20 years to health span. The question really is, will we also add time to lifespan? And yeah, that's why we go to work every day. It's it's a tremendously exciting time to do this. Yeah. And you kind of brought up health span and kind of longevity there. I feel like we've used the term longevity a little bit too much lately. It's finally starting to catch on and it's kind of the hip thing on YouTube and all those other areas to talk longevity. But I think we need to catch up health span with longevity because, and that's what you've been talking about is that, you know, we've gotten to a point where we can get people living longer, but the quality of those years living need to kind of catch up with the years. And it sounds like your research can really make some very interesting, exciting headway headways into that. So I'm really excited to hear what's on the horizon for you and for listeners and viewers and people like myself that want to. Explore Vegas Nerve Stimulation. What steps would you recommend that they take? They're well, I do have a book in production, Jeff. Great, plug it! I have a book, I have a book that is available on pre sale now. It's coming out in May. It's called The Great Nerve. And the reason for the title is that Galen, one of the ancient Greek physicians I referred to earlier Galen named the vagus nerve the Great Nerve, and it was actually called the Great Nerve for almost 1800 years. It was actually renamed the vagus nerve. Not that long ago in the 1800s. So I don't think Vegas, which means wandering. I don't think that's the right name for Vegas nerve. I mean, when I look at it and I've looked at it in people and I've looked at it and it's not wandering, it knows exactly where it's going and what it's doing. It's complicated. It's great. So, so my book will be out in May. There are a tremendous amount of scientific treatises that Dive into great depth for your audience that either has that background or wants to really dive in deeply. There's hundreds, if not thousands, of very well written review articles that cover, some by my colleagues and I, many others by other investigators and scientists and clinicians. So they can get, you can find those on either Google Scholar or PubMed. And then, But I really saw a need to get my book out to try to bring together, as we have in this conversation, some of the complicated science and history. But also some of the unanswered questions, because there's many unanswered questions. So there's huge opportunity, but but there's a lot of unanswered questions. And so your book where would it be available? Is it Amazon? So, yes, it's available everywhere now. Okay. So we'll make sure we get a link to that in the description notes that people will buy that. I will certainly get a copy cause I'm excited to kind of read it. I miss teaching anatomy. I've taught, I taught anatomy for a number of years. That's kind of my minor and my PhD. And so I get kind of geeked out on all this stuff. I don't know if our listeners and viewers get quite as geeked out as I do, but I'm sure there's some out there that will definitely get a little bit more geeked out. But I think it's a fascinating. Future and what excites you the most about the future of bioelectric medicine and its potential for transforming Aging and health care the idea that the technology is racing ahead faster than we can imagine. I mean things are getting smaller. The computers are getting more powerful the ability to develop brain computer interfaces as well as vagus nerve interfaces You is racing ahead faster than people can imagine. I mean, you know, credit to Neuralink for building a brain computer interface that's fully implanted by robots. So one neurosurgeon can supervise some number of robots. And if you think about that for a minute, that solves the problem of, that solves the problem of if these devices become so popular. For some, for treating either aging or other conditions of inflammation or paralysis or stroke. There won't be enough neurosurgeons to put them in manually. So the, having the robots put these in is, so I see all these things as not tomorrow. But not tomorrow. not in some future era of flying cars. This is going to happen in the lifetimes of many of us. And it's going to have a big impact on the health span of many people. And I look forward to seeing that. To me, it's inevitable. And I think we've all been waiting for flying cars in our lifetimes and it hasn't come. So I think we have a little bit more hope of this stuff coming in our near future, more so than flying cars. Well, you and I remember the Jetsons and some of your audience doesn't know what we're talking about but this is not, the things we're talking about in this conversation in this podcast, this is not 20, 30 years off. This is coming in the next probably 5 or 10 years for some of these things. That's exciting. And especially, you know, for the individual I know with rheumatoid arthritis and suffering from, you know, fibromyalgia and a lot of these conditions that are just really chronic, painful conditions, I think it should give them some hope and some excitement. You're absolutely bringing up a critical point. So. You have to talk to these people to realize, you know, rheumatoid arthritis is not like, you know, grandpa sprained his knee playing football in high school and I have arthritis. That's not, that's, these people are, these people, many of these people are suffering. They can't pick up a pencil to write a note, they can't button their, Buttons on their blouse. They can't go to work. Same for fibromyalgia. These can be debilitating conditions. So when people hear, Oh, it's going to be a surgery to treat these conditions, you know, there's, there seems to be, there seems to be sometimes more resistance from the healthcare community talking about surgery for a rheumatoid arthritis condition than there is from the patients. The patients I've talked to when they run out of therapeutic options and they're suffering. Yeah, I'll try this. Yes. Sign me up. How do I sign up? So it's going to be a very interesting time. You know, this is a very new idea to use a. a bioelectronic, you know, neuromodulating device to treat conditions that for decades, if not centuries, have been treated with medications and ointments and liniments and heat and cold. Now you're talking about, now you're talking about surgery. Yes, we're talking about a simple, relatively simple surgery, same day that may, change the quality of life, if not the entire trajectory of healthspan for something like a million and a half people in the United States today would be eligible for this treatment for rheumatoid arthritis alone. When you put in other future conditions that, That I hope will be studied like multiple sclerosis, inflammatory bowel disease, potentially long COVID, potentially fibromyalgia, potentially other conditions we talked about. Now you're talking about tens of millions of patients who, we can't do it now, we don't know enough, but tens of millions of patients someday may benefit from this approach. That's, that, what I want to, what I want to know is that my colleagues feel as strongly as I do about at least studying it, because these are fair questions. Yeah. And exciting questions. And was there anything we missed talking about that you'd like to add at the end of this podcast? No, we didn't get into specifics about how many pushups to do or how long to run on the treadmill, but I don't think we should. And cause I, I think we covered ground at a level that's that's actually very relevant, very important, and hopefully we'll clarify some thinking in, about what needs to be done next, because there's a lot to do next. Well, I, again, thank you for your time today. This has just been enlightening to me. And if I'm the only one that hears this conversation, then I'm good. But I hope that a lot more people will listen to it and it will certainly lead them to, you know. Listening a lot more to the podcast because you're the type of guest that we really want to have on here more because to me this Preventative side of aging is what's really most important and dealing with the issues that are coming up Not by just masking it with drugs, but actually dealing with you know, coming up with solutions to the problems And so I'm excited for your research. I wish you all the best with it I'm gonna keep up with it and I'm just gonna tell you to just keep aging. Well Thank you and thank you for having me on. It's been great talking to you. You're welcome. Thank you for listening. I hope you benefited from today's podcast and until next time, keep aging well.