You May Need a Vagus Nerve Reset–Here’s How to Do It

Boosting low vagal tone can also help a number of medical conditions such as epilepsy, high blood pressure, Parkinson’s disease, rheumatoid arthritis, atherosclerosis, inflammatory bowel disease, diabetes, and cardiovascular disease, and prevent early mortality [1].

There are several low-cost, low-barrier-to-entry treatments for a vagus nerve reset that are safe and effective for many conditions that are tied to vagus nerve dysfunction. Lifestyle interventions like gentle exercise, a nutrient-dense diet, and a meditation practice can go a long way in helping reset the vagus nerve.

Since electrical vagus nerve stimulation isn’t realistic for most people, due to its limited use and higher potential for side effects, the natural, safe, and research-backed treatments I discuss here are probably a better place to start when healing your nervous system. They also take a more holistic approach as they can help heal many other body systems, not just the vagus nerve.

The Nuts and Bolts: What Is the Vagus Nerve?

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The vagus nerve (there are technically two—on the left side and right side of the body) is the tenth cranial nerve that originates from the lowest part of the brainstem (called the medulla oblongata). It runs deep in the neck and into the chest and abdominal cavities, connecting various organ systems—including the gastrointestinal system, heart, lungs, tongue, and pharynx—to the brainstem and cortex. It’s the longest cranial nerve in the human body [2, 3].

The literal translation of the word “vagus” means “wanderer,” which reflects how wide and far-reaching this nerve is in the human body. It contains motor and sensory fibers, which send nerve impulses both to and from the brain. The sensory fibers can detect pressure, pain, stretch, temperature, chemical, osmotic pressure, and inflammation in the organs. The motor fibers supply muscles of the pharynx and larynx that we use for swallowing and speech [2, 3].

If you’ve ever fainted or gotten woozy at the sight of blood, an intense injury or sudden pain, or other stressful stimuli, it was likely a vasovagal malfunction called vasovagal syncope. This is the most well-known type of vagal disturbance where blood pressure drops, temporarily reducing blood flow to the brain and resulting in a brief loss of consciousness (usually a minute or less) [4].

Vagus Nerve and The Parasympathetic Nervous System

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The vagus nerve carries 75 percent of all parasympathetic nerve fibers in the body, making it the primary component of the parasympathetic nervous system (PNS), which is part of the autonomic nervous system (ANS). The other part of the ANS is the sympathetic nervous system (SNS), which governs fight or flight, as well as most voluntary actions.

This is why diet is a fundamental component of a vagus nerve reset, and why I prioritize nutrition in my practice—especially when the above symptoms of vagus nerve dysfunction are present.

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What Is a Vagus Nerve Reset?

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Many studies have linked various gastrointestinal, neurologic, and cardiovascular/metabolic diseases to reduced vagal tone, and this has led to exploration into how stimulation of the vagus nerve can improve health. Vagus nerve stimulation is also referred to as vagus nerve therapy or, more loosely, a vagus nerve reset.*

The goal of a vagus nerve reset is to get the two parts of the autonomic nervous system (parasympathetic and sympathetic) back into balance, thereby helping to heal symptoms of nervous system dysfunction.

Any technique that stimulates the vagus nerve, including manual or electrical stimulation, constitutes a form of vagus nerve stimulation (VNS). However, there are other ways to reset the nerve that doesn’t involve direct stimulation and are likely a much more effective place to start.

*Slight disclaimer: I’m about to dive into a discussion on the various therapies that could be employed for a vagus nerve reset. I want to highlight that in general, it appears that behaviors and holistic modalities that are known to be good for overall health also seem to be good for improving vagal tone. Being overly focused on stimulating the vagus nerve may be unnecessary. 

Holistic Forms of Vagus Nerve Stimulation

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This is the list of interventions that include healthy lifestyle habits that we know are good for your overall health generally. However, there are also additional interventions in this category that are geared specifically toward improving vagal tone.

Oddly enough, this seems to include simulated (fake or forced) laughter. A very small 2012 study looked at the effects of laughter on HRV and mood in patients awaiting an organ transplant (high stress!). It compared the effects of simulated laughter, stretching exercises, clapping, and meditation for 20 minutes to a control group that only had discussions about their health [13].

The results showed that the laughter group had immediate improvement in mood and HRV—the best measure for vagal tone, which I discuss below. Both groups had improved long-term anxiety [13].

Another study showed that laughter may reduce the risk of heart disease and stroke (which are linked to poor vagal tone), even after controlling for other risk factors like high cholesterol, blood pressure, and body mass index [14].

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Nutrition

As discussed above, proper nutrition is vital for healing the vagus nerve. Reducing your consumption of inflammatory foods like sugar, trans fats, processed foods, and alcohol can go a long way in reducing inflammation and nervous system hyperreactivity.

A Mediterranean diet is pretty non-restrictive, and research shows that it is linked to better vagal tone [9]. It emphasizes the consumption of fatty fish, moderate amounts of polyphenol-rich red wine (no spirits or beer), yogurt, and nuts like pistachio, which are all shown to be good for improving heart rate variability (a measure of vagus nerve health).

However, I tend to start my patients with a Paleo-style diet, as it eliminates even more common inflammatory foods, like dairy, eggs, and corn. If a Mediterranean diet doesn’t seem to resolve your symptoms, a Paleo elimination diet can often help.

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Exercise

An effective vagus verve reset is likely going to include some sort of physical activity, as research consistently shows that this is one of the best ways to normalize heart rate variability and boost vagal tone [15]. While this might look different for everyone, the key here is just to get moving.

Another type of massage, known as a carotid sinus massage, involves exerting light pressure with the fingers on one side of the neck where the pulse from the carotid artery can be felt the strongest. However, carotid sinus massages are typically used in emergency medicine situations to slow rapid heart rate and improve abnormal heart rhythms. It can cause adverse effects, especially in people with underlying heart conditions and carotid artery disease [17].

For this reason, I don’t recommend starting here, especially without a health care provider to guide you on using the proper technique.

Ice massage applied to the head and spine may also improve HRV when compared to tap water massage or massage using no water or ice. A study done on 30 healthy male subjects had the participants lie face down while receiving an ice massage over their heads and spine. Compared to the no-treatment and water massage control groups, those who received ice massage had significantly reduced heart rates and improved HRV [18].

Cold water facial immersion also seems to be effective in improving vagal tone [1]. Cold exposure (with ice packs, cold air, or cold water) has a number of other known benefits as well. This makes it one of the top vagus reset therapies that comes with little-to-no risk and is easy to implement. It would be interesting to look more deeply into cold exposure and vagus nerve reset, but for now, it appears to be effective for reducing symptoms of nervous system dysfunction.

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Slow Breathing Exercises

Deep breathing activates the PNS and tells your body that it can calm down and relax. In contrast, in fight or flight response (when the sympathetic nervous system is active), short, shallow breaths are more common. By taking deep breaths, you can tell your brain to calm down and slow down the stress response in the body.

Using Heart Rate Variability to Measure the Vagus Nerve Activity

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So how do you know if you need to work on your vagal tone anyway?

Activity of the vagus nerve, also referred to as vagal tone, is measured indirectly through heart rate variability (HRV), which is the fluctuation in time intervals between heartbeats. High HRV is associated with higher vagal tone and better health and represents the ability of the nervous system to be adaptable and resilient during stressful situations and to return to baseline afterward [20].

Even though higher/optimal levels of HRV appear to be associated with health and lower HRV is associated with lower vagal tone and worse health, there are no definitive reference ranges constituting normal or healthy HRV [21, 22].

What’s more important is looking at your HRV trend over time (which can be done with a smartwatch or fitness tracker) to see if it is consistently low or has frequent and/or drastic dips. This is a sign your nervous system is taxed and can benefit from a vagus nerve reset.

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Electrical Vagus Nerve Stimulation

Electrical VNS is a more invasive method where a small implanted device is surgically placed just under the surface of the skin (usually on the left side of the chest) to stimulate the vagus nerve. It’s FDA-approved in the treatment of epilepsy and treatment-resistant depression and is also being explored for the treatment of obesity, stroke rehabilitation, male infertility, autism spectrum disorders, migraines, tinnitus, autoimmunity, and inflammatory disorders [2, 3].

This treatment is reserved for the above conditions, and its invasive nature and high cost make it a less preferred method for vagus stimulation in the general population (best stick to cold water and targeted breathing techniques).

In ctVNS, the electrode is the same, but the placement is different. It’s placed on the neck area over the sternocleidomastoid muscle near a branch of the vagus nerve [24]. We don’t quite understand why or how providing direct electrical impulses to the vagus nerve helps, but it provides a positive result for a number of patients.

There is no standardized protocol or set of parameters that are proven to yield the greatest therapeutic benefit for specific conditions in these treatments. While these may have a more predominant place in improving vagal tone in the future, trying low-cost, at-home methods that benefit your overall health is probably where your resources will be best spent.

Let it be a comfort that so many established self-care and healthy lifestyle habits like exercise, mindfulness, and nutrition already have a positive impact on vagal tone and heart rate variability. There are also a number of other holistic, complementary interventions like music therapy and targeted breathwork that can improve vagal tone.