Arizona Center for Integrative Medicine

Transcript

Victoria Maizes: Hi, Andy Andrew Weil: Hi Victoria Victoria Maizes: Today we will be speaking with Stefan Chmelik, who has created a very interesting toning device for the vagus nerve. Andrew Weil: Well, the Vegas nerve is much in the medical news these days. You know, it's getting a lot of attention. As a master regulatory of our physiology. Victoria Maizes: So let's get him on. Andrew Weil: Okay Victoria Maizes: Stephan Chmelik is a traditional Chinese medicine physician, who is also trained in body work and trauma resolution. He has extensive personal experience with meditation and breathwork, and he's the inventor of Sensate, a vagus nerve toning device, that uses sound and vibration to quiet the nervous system. Welcome, Stefan. Stefan Chmelik: Victoria, thank you great pleasure and honor to be here. Victoria Maizes: So to begin I just want to talk about the vagus nerve, which is the longest cranial nerve in the body, and the definition of vagus comes from Latin, which is wandering, and it literally wanders. It begins in our brain, and it moves down through the neck, and then into the body, into all or many of the organs of our body. Why is it so important? Stefan Chmelik: It's a great question. You would think that it had been recently discovered by the amount of interest there has been for it. But of course mammals have had a Vegas nerve for 800 million years or so. So it's it's not really new per se I think, with the vagus nerve what's happened is that a lot of the functions that we attributed to other structures are now being seen as being partly due to vagal nerve response. Stefan Chmelik: There are a number of internal senses, properception, interception, cognitive perception, various types of nervous system responses which are, in addition to the 5 senses that we more classically know that we all have. the Vagus nerve has a snappy name and a snappy title. So it's easy to kind of focus on and memorize. But of course it is important to realize that it's part of autonomic nervous system. So it's the largest nerve, indeed, in the in the body, but also in the autonomic nervous system and it mediates, the kind of internal an external world. So, how we feel about things and how and how we process information from the brain, because, as you say, it starts in the brain and it wanders all the way down into the pelvis. Actually, you won't see that usually delineated in anatomy books. But I've dissected out. It does go right down into the pelvis. So it does have a function on sexual function. And your eurogenetry problems as well. So there is a a broad range of indications Andrew Weil: what I learned in medical school was that the Vagus was the main conduit of the parasympathetic nervous system. Whereas the sympathetic nervous system did not have a trunk conduit. It was much more diffuse anatomical system. Stefan Chmelik: Yeah, we have this fairly rigid definition of the autonomic nervous system, the central nervous system, the parasympathetic and the sympathetic nervous systems. But as we're finding with the brain and the supposed idea of the 2 hemispheres, the brain, large parts of the body and large parts of the nervous system are involved in multiple things. We tend to talk about the sympathetic in the par sympathetic nervous systems in relationship to either flight, flight, freeze, kind of emergency, response, mediation or rest and digest relaxation mediation. a recent piece of research. For instance, indicates that a whole man called osteo calcium is actually at least as responsible for the flight to fight responses adrenaline which is produced in the musculoskeletal system and and the facia. we're learning that things are much more diffuse, holistic, and and whole body, mind, body Victoria Maizes: You said something interesting. You refer to its relationship to the feeling of safety, which to me seems very different than rest and digest. It's a much larger concept. I'm wondering if you could say a little bit more about the parasympathetic nervous system and its relationship to safety. Stefan Chmelik: YeahI think it's vital as far as I can see, and from my clinical experience as well, which was mostly around, working with people like anxiety and trauma, being able to feel safe, which of course, is a big part of the therapeutic relationship. A big part of what a good doctor does with their bedside manner is enabling somebody to feel safe and relaxed. If a person can't feel safe then there's really nowhere for them to go If we talk about Maslow's hierarchy of needs, which is interesting cause actually, Maslow never talked about the hierarchy of needs. But later on, this concept of the hierarchy of needs was attributed to him, and certainly we can say that there are some needs which have to be met before higher functions can be can be met. I tend to think that feeling safe is ground 0 that. All other needs are built on that. And I've been thinking a lot recently about the nature of trauma which has been increasing recognition of and the fact that you really wouldn't be able to find a population of people anywhere in the world who wouldn't have some element of trauma, who hasn't been victim of slavery, holocaust, colonization, invasion, war, famine, I mean, and the world made sense to me when I realized that pretty much everybody in the world has some type of trauma. And then, if you look at the information that suggests that trauma is passed down through 7 generations. Then I think you'll you can so see the kind of critical mass that we're seeing now in the world. Victoria Maizes: So take us back, then, to how stimulating the vagus nerve, or perhaps toning the vagus nerve, is a way of making people feel safer in their bodies. Stefan Chmelik: Thank you for distinguishing between toning and stimulating. I tend to reserve the use stimulation for electrical stimulation, or some kind of you know, physical manual stimulation tends with the nervous system tends to mean electrical you can make a muscle or a nerve twitch by putting electrical impulses through it. On the other hand, a gentle and more holistic approach is to undertake practices which encourage a system to become stronger, to become more flexible, to become more resilient. Stephen Porges, originator of poly vegles. There it talks about vagal flexibility and vague resilience We can think of the vagus nerve as the anatomical manifestation of what we call the gut brain superhighway, you know, which is a fairly well used terms, so this literal pathway between the brain and the gut we can think of as the vagus nerve. And we know, you know we we know that most of the things we feel are body feelings, you know. We don't think we're in love. We feel in love, right? We don't think we're afraid. We feel afraid. And we have gut feelings that we're missing, and something can feel like a kick in the gut, a twisted the guts. So we know that a lot of emotional feelings and responses are processed by the digestive system. And it's really the way that we feel about things in my experience has a bigger impact on our on the decisions we make than how we think about things. which is why, in a no amount of data will sway somebody's decision. What will sway their decision is how they feel about it, which is why it's taken so long for most populations, for instance, to give up smoking. It's not about the data it's not about, you know. Nobody can argue with the data smoking. It's how it makes you feel when you smoke, which is for a lot of people is very relaxing sensation. So, by mediating the internal and external world, by mediating how people feel increasing the tone, the flexibility, the resiliency of the vagus nerves enables people to cope with higher levels of discomfort. Higher levels of stress. the term I like to use these days is anti-fragility. Not term. I invented by any means. But I think that's A good term, because it's a uniquely biological concept. Stefan Chmelik: You know, we can build a mechanical device which is highly resilient. But you can only have a biological system which has anti-fragility, the idea being that it gets stronger with learning. Andrew Weil: So how can we tone the vagus nerve? What are the methods available? Stefan Chmelik: Yeah. So people have been toning their Vagus nerve for the last few 1,000 years. This is where we see ceremony and ritual and practice sacred practice, particularly. You see, common links here with modern practice. The use of voice and sound and chest. yeah. So if you can make the chest resonate, given the location of the Vagus nerve behind the sternum. It, as you say, it travels many places, but the primary location behind the sternum. So you can create resonance and humming and homing mantra like sounds in the chest. You can't stimulate the vagus nerve that way through vibration, and we know humming. We know gargling our stimulatory for the Vagus nerve. With the technology, I've developed Sensate, we're essentially doing that. But the rather than using your voice box to create the hum to create the resonance you're using a device that sits on the chest and uses bone conduction to stimulate the air in the thoracic cavity, because there's a lot of space, and there's a lot of air in the thorax. So it acts very much like the speaker in your hi-fi. So you could have a beautiful speaker. But if you stuck it in an old biscuit tin, it's not gonna sound good. So so you, so that the Sensate is like the speaker and your chest, is the is the beautiful Hi fi! So the you know all the air and the resonant capacity through bone conduction into the chest is where you feel the the whole body vibration from. Victoria Maizes: When I was in medical school I learned that putting your face in ice water stimulated the vagus nerve. I don't understand the mechanism behind that, and I also learned that you could just directly massage it. You know you could go next to your carotid artery, and you could massage it. Stefan Chmelik: Yeah, I mean there, there's this reptilian reflex. Supposedly but if you if you kind of drop your face into cold water, it will produce a kind of a startle response. I'm not sure that's a great thing. A lot of people are advocates for cold water exposure. Certainly, that has biochemical effects on the white and the brown adipose tissue. And there's very good research for the longevity benefits of regular cold exposure various explanations as for how that might be working. I think by increasing resiliency, you are working on vagal tone. Nothing, I think, resiliency and anti-fragility and variable tone are you know, almost different words for the same thing. Andrew Weil: And what about breath control Stefan Chmelik: Well. Absolutely, of course, breath is perhaps the only autonomic function that we can easily exert influence over. Unfortunately, usually, that means we're exerting a negative influence. So people tend to hold their breath. I've never found somebody that forgets to breathe in, but I frequently meet people who forget to breath out. It's very easy to hold one's breath, and so that's become a habitual patterns you know very well. Stefan Chmelik: My experience of breathwork, and as somebody who was told to meditate at a very young age, by my dad and who's studied breath work for 40 years or so? Is that if somebody's autonomic flexibility isn't already there, then like meditation. It can quite easily have a negative impact. So one of the best ways to make somebody have a panic attack is to say to them, “and now notice your breathing.” Which for many people t they'll notice they're breathing right, and they'll realize they're not breathing that great, and then, because they notice that they'll start to hold their breath, and then the CO2 will go down, and they'll feel worse. One of the main reasons I developed the Sensate technology was, I was finding that a large number of the people that came to see me that wanted that needed to relax actually felt worse when they tried to follow classical meditation or mindfulness. Meditation, type techniques um which I think is not that surprising, even if you think about it. You know we live in a world where people are massively overstimulated. So to then ask somebody to sit down and notice themselves, and to become aware of how they feel for 10¬†min can be quite challenging. Victoria Maizes: it is interesting that we're in this era where we're beginning to use devices to tone the nervous system as opposed to breathing, chanting, om-ing, other non technological ways. And yet we are. And there's a very large body of evidence, you know, starting with implanted vagus nerve stimulating, true stimulating for epilepsy and migraines to now superficial either right over the vagus nerve, or as Sensate, is over the chest, sometimes on the ear. And and the research is really profound and very, very diverse. You know, headaches, Parkinson's, POTS, which is postural orthostatic hypertension tachycardia, syndrome. So it's it's fascinating that there's such a wide range of potential uses not just for helping to reduce people's sense of anxiety. But in many other physical conditions. Stefan Chmelik: Well, it does seem like a lot of the modern ailments that affect us are to do with the autonomic nervous system. Andrew Weil: Yeah, you know, a frequent diagnosis that I make which is not official in the US is autonomic dysfunction, and I will write that in my notes I was very happy to see in Japan. That is an official diagnosis. But it's obvious to me. I've also said that if I have 10s with a patient to make a diagnosis, the best thing I can do is feel their hands. If if people have cold hands in a warm room that is to me a sign of it, an autonomic imbalance with overactive, sympathetic activity. And they are in great need of of vagal toning. Stefan Chmelik: So Andrew, what do you do? What's your approach when you find somebody who has this kind of issue? Andrew Weil: Well, I I depends on the person, and my intuitive sense of you know what their makeup is. I might, if they're open to it, send them to a hypnotherapist. I might send them to a biofeedback practitioner, I might teach them my 4, 7, 8 breath, which is, you know, a favorite breathing technique. I think it depends on the person. And they'll resonate with, I have had people, this is what similar, what you said. I've taught them that 4, 7, 8 breathing technique, and they say they become more anxious when they do it. So that requires a different approach. Stefan Chmelik: That's what I like about the use of something that has physical, tactile capability. having that physical embodiment of a feedback seems to be really important. I mean, I've used a lot of biofeedback as well, and II think biofeedback's amazing but it tends to be either auditory or visual rather than physical. Yeah. And again, this, what I found really over decades in the clinic was that without that embodiment You're gonna get a percentage of people who disassociate. And as far as I can see, the percentage has got higher and higher over the last decade or 2. Andrew Weil: Yeah. Yeah. Victoria Maizes: So one thing I have found in recommending Sensate to a number of people and using it myself is that in some ways it requires that you lay still for 10s min. In fact, I listened to a person compare Sensate with ApolloNeuro, which is another vagal nerve toning device to wear it usually on your ankle, but you don't have to stop. You can just wear it with whatever activity you're doing. And the person was saying how wonderful it was you never had to stop. And I'm thinking, therein lies the problem. Stefan Chmelik: it's like, the ubiquitous comment from the meditation teacher when you say, but I you know can't. I can't find 10 min to meditate. They go. Well, then, you need to. Then you need to spend an hour. We have been criticized by some people saying that with any reason people that use sense for better is cause that this this they're lying down and not doing anything for 10 mins. Which feels a little bit like doctor saying, the only reason holistic patients get better is because we're nice to them,which is always seem like a strange criticism to me. But we've done enough research now to know that there are biological and biochemical effects. And actually, what we see a lot is is neural synchronization in the brain. We've seen that across a couple of studies now, which is very interesting, because that's essentially what you get in meditation. You get kind of neural synchronization. So it's interesting that that's what we're seeing with people, even though we're not targeting the brain. In fact, we're trying to not target the brain cause. I think the brain is really complex, and nobody really understands what's going on up there. But by working on the chest, the heart, the thymus, and the body. It's obviously sending some kind of, you know positive signals to the brain that everything's okay, and you can kind of harmonize, and and it's all good. Victoria Maizes: You know, you mentioned Stephen Porgis earlier, and one of the things that I understand about his polyvagl theory is that he really points to this third part of the vagus nerve that's responsible for social engagement, which, of course, is something we tend to do when we feel safer. What I haven't seen him do is link that to the work that Shelley Taylor at UCLA did the tend and befriend, you know that that's this other part of how we as a species, have managed our anxiety or our, reaction to stress. So to me, that whole piece of when you're super stressed, you can't engage with others. Stefan Chmelik: I think that's tend and befriend, and there are a number of other ideas and concepts between brought in so fone and freak. And so I forget something. Others is in in addition to flight, fight, and freeze. There seems to be some unwritten rule that it has to begin with f, I think we, I think we're gonna I think we're gonna run. Well, there's a few more we could think of. But I think we're gonna run out next as well. Then Andrew Weil: Can you summarize poly vagal theory for us? Stefan Chmelik: Oh, my word! okay, what I think it means. Steven can tell me I'm wrong later. I mean for what I what I think the beauty of polyvagal theory for me is that it's created a recognition, amongst clinicians. Or you know, trauma based clinicians in particular, that we have a body as well as a mind. Yeah, and that we're not brains in a jar. And that we can't be treated like brains in a jar I don't mean. You know, we won't be treated like brains. I mean, if you actually want to have a clinically positive outcome, you have to recognize that we have minds and bodies at the very least. And that I mean over the last few 100 million years of evolution. Connection, as you say, Victoria is a major element within the way in which we've learned to self-sooth and self-pacify and to feel safe.We've developed and grown up in communities. We have connection with animals and with nature, or we did until fairly recently. And that's part of the problem, right? You know, we know that connection with nature is quite possibly the most powerful healer anyone can also have. So And and I think sound is the great unify here. Yeah, we've become very reliant on visual sensory data. But I think sound is something that we all experience in a profoundly different way. In time and space. To visual information. Sound in particular is not so brain orientated. And my hypothesis is that we only hear about 50% of sound. that the other 50% is experienced via vibration and other receptors in the body, some of which haven't yet necessarily been classified as such but that I'm quite confident that the discovery of fascia of connective tissue is a sensory organ which is essentially water a fluid, gel-like matrix. And anyone who's been up a mountain and dropped pebbles into a pond knows what happens when you stimulate water Stefan Chmelik: Increasingly, in anthropology there's an idea that language came from song. Not the other way around that we started having the ability to speak complex language because we sung to each other. Andrew Weil: Huh. Stefan Chmelik: And human language is very complex. It's unique. Only birds can produce complex sounds in the way that we can. what I love about sound also, is that how it confounds Darwinism because there were so many elements to sound and to music and to dance which don't necessarily provide a classical Darwinistic survival advantage, but yet we do them and in many ways those are the things which make us uniquely human. Victoria Maizes: Andy, I imagine, in your travels around the world, you witness the use of sound and vibration in many cultures. I'm wondering if you Andrew Weil: Well, I'll tell you 1 one story. Some years ago I was at the Field Museum in Chicago and it was a founders night where their big donors had come, and there were various presentations, and one of them they had a a very large, I think it was antique gamelan ensemble collection of Indonesian gongs and drums, and they got players to play this these vast instruments, and it was in a big hall which had great acoustics, and 1 one of the pieces they played was a war chant that was designed to prepare people for battle somewhere in the middle, that I could just feel this in my body. I wanted to smash things. I wanted to just run out and smash things it was a very powerful experience of seeing how sound could really control my emotions. And and in a sense, my body. Victoria Maizes: I'll give a little testimonial. I've known you, Andy, for 26 years, and I've never known you to want to smash things Andrew Weil: Never played the right music. Victoria Maizes: I’m not going to either. Stephan Chmelik: Hey lets not go to war. Andrew Weil: But you know I wonder when I’m driving around and car pulls up next to me with a boom box at top volume, and you know what is the effect of that on the nervous system of of the person in the car and the people around it, and I think people are very unconscious of the sounds that they expose themselves to. Victoria Maizes: And the reverse of that, of course, is when a mother sings a lullaby to her baby. Stefan Chmelik: Yeah. And of course, human experience. Our first experience is sound is via bone conduction water transmission as you say, you know the the first sounds of baby his it's mother through bone and through fluid. So neural pathways developed to hear that and to expect that. Stefan Chmelik: And I think that's why sound is very different from electrical stimulation, even microcurrent electrical stimulation. So I am also in aw as are you, Victoria of the medical applications, Vagus nerve stimulation, the implantables and the subcutaneous devices. I think that's brilliant but it's a different. It's a specific field of medicine. And it's not what we're doing using acoustic stimulation to enable the autonomy, nervous system, and the chest, and the thymus, and the heart and the lungs, and the diaphragm to go into a kind of harmonic rhythm which then creates a mind, body, connection is a is a very different experience. And I think there is a move towards this is moved towards back to nature. There's a move towards people being interested in ritualistic, shamanistic. a more ancient knowledge. Stefan Chmelik: But there's also a need it seems to provide this in a kind of easily assimilate, assimilable format for people in the short term as well. So my my hope is that of. I mean, we're we're on like 60 million minutes or something like that. There's a lot in a lot of lot of minutes have been spent on Sensate. The kind of testimonials we get are, make me cry on a regular basis. You know, people whose lives are have been changed every day. We get kind of spontaneous descriptions from people who were suicidal, who were victims of trauma in various and various shapes or forms and who absolutely say that their experiences with Sensate has change their lives, which is a beautiful and wondering, wonderful thing, and a great honor to be part of. But we know that people are so overstimulated and so many people are on the edge of this association that asking them in many cases to, you know, go off and do a you know, at the 10 day Vipassana retreat. 10 min. meditation exercise is, is, it's not going to do the job. So what do we do? This is this is the crisis that I felt I found right. So what do we do with this people? Do we say? Well. not my problem. I can't help these people, the techniques I've been trained in don't work for them, but they work for these people. And I'm gonna work with these people. And my my experience is the people that can meditate. People that are able to self regulate are the ones that we don't need to help. gonna find a way, one way or another it's the people that need the help that I want to reach out to. Victoria Maizes: Well, Stephan, thank you so much for the work you're doing, and for the deep caring you have for all the folks who are struggling out there. And for this wonderful device that you've created, we appreciate talking with you about it. Y Stefan Chmelik: thank you so much. I appreciate being here. It's it's always fantastic to talk about the work we do, which is a great honor to be part of.