Sock Doc 18: Destress Now, Be Healthy Later — Guide To The Vagus Nerve and More On Mastering Your Stress And Boosting Health Outcomes

November 4, 2022


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Dr. Steve Gangemi, The Sock Doc, is a natural health care doctor who founded and practices at Systems Health Care, an integrative wellness center in Chapel Hill, NC. Steve is also a longtime endurance athlete and is a wealth of knowledge for athletes looking to optimize wellness.

Vagus Nerve 101

  • What is the vagus nerve? What purpose does it serve?
    • Longest cranial nerve in body, 10th.
    • Parasympathetic activation; rest and digest.
    • Helps to balance us from a nervous system perspective.
    • We use this to look at someone’s overall parasympathetic tone
    • Vagus in latin = wandering, goes to many parts of body:
    • Pancreas, liver, gallbladder, spleen, heart, gut, etc.
    • Where doesn’t if affect?
  • Connects organs below neck to the brain.
  • Transmit system.
    • 80% afferent – gives brain signals back from organs.
    • 15% efferent – brain responding back down to organs (crosstalk).
    • 5% – 3-4% to vocal chords (exercises like gargling to stimulate); 1% a little bit of the outer skin part of ear (devices that can stimulate)
  • When and how do we correlate a health issue we’re having (eg gut health) with a vagus nerve dysfunction?

Stress and Vagal Tone

  • Chronic or acute stress can affect vagal tone.
  • How vagal tone affects HRV.
  • Breath in vs breath out to discern parasympathetic tone.
  • Improve with breathing exercises. 
  • Mindful practices we can do to help vagal tone:
    • Gratitude, appreciation and memorable events 
    • These three things and the thoughts and feelings we get form them, and feel in the heart, can positively influence HRV / vagal tone
  • When we work on vagal stimulation, we influence diaphragm, affect stomach function (e.g. hydrochloric acid function and improved digestion), etc. 
  • Gut transit time can be an indirect measure of vagal tone—the longer it is, the worse our vagal tone.
  • Chicken or the egg?
    • Look at it as a system dysfunction (breathing, gut, cardio) sends feedback to vagus nerve and can cause diminished vagal tone
    • We can’t hum or gargle our way through the day and expect that to work magic if we have a poor diet, poor breathing and other dysfunctional issues taking place (poor breathing), etc…
  • Vagus nerve releases acetylcholine (which lowers HR).
    • Poor focus, poor concentration, reading comprehension, trouble following directions, neuromuscular fatigue—all signs of low acetylcholine.
    • Overtraining/chronic cardio uses up a lot of acetylcholine.
    • Acetylcholine is the main neurotransmitter of the vagus nerve. If low diminishing function of vagus nerve, but if vagus nerve is always overstimulated then you can use up acetylcholine levels. 
    • Acetylcholine is made from choline, which we get from diet, mostly animal-based foods (pasture raised egg yolks, grassfed meats); hard to get from vegan diets (nuts?).
    • Choline can cross blood brain barrier.
    • Higher protein/fat diet helps us get and maintain sufficient levels of choline for improved vagal nerve functioning.
    • If acetylcholine levels low, can contribute to uncontrolled inflammation.
    • Enteric nervous system tie in.


  • Chronic uncontrolled inflammation, dependent on a healthy functioning vagus nerve
  • That 15% coming back down helps put the brakes on the inflammatory storm (the brain needs to tell the body to calm down the inflammation response, strong vagal tone needed for this to occur)
  • If we then are inputting excess stress whether diet, over-exercise, life stress, etc… things can spiral.
  • What about exercise? how do we monitor the level of exercise we’re doing to make sure we’re in a sweet spot for healthy vagal tone:
  • Does inflammatory response of exercise (repeatedly) hinder vagus nerve function? Or, can chronic inflammation block the vagus nerve from doing its job?
  • No special formula here. If you’re training too hard you’ll influence everything we just discussed above; never in isolation. Eventually that 15% that the vagus nerve does to send info back down from the brain, begins to struggle. 

Benefits and Examples of Vagal Tone Exercises

  • Are more people starting to see and feel the beneficial effects of vagal tone work? Lots more talk about it these days.
  • Stress reduction techniques for vagal tone—how effective are they?
  • If you just need a little vagal stimulation small things will work, but many people are more globally suffering from other systems gone awry; e.g. overtraining, over-stressed, etc—gargling won’t solve that.
  • But a sound training plan, with plenty of time and healthy techniques won’t diminish vagal tone or cause vagus nerve issues as much, so in this scenario using the vagal tone exercises may help a lot more.
  • If vagus nerve is already not working well, gargling or humming alone won’t fix digestive problems or something bigger happening.
  • However, these vagal tone exercises are a gentle way into easing someone into a better, healthier internal environment with improved vagal tone and health—start small and feel the difference. 
  • And we DO recommend these vagal tone exercises such as cadence breathing, humming, gargling, etc. 
  • Look at it the other way: maybe you can’t handle the stress because you aren’t breathing well. 
  • Tie in with HPA axis and symptoms of being overstressed… the point is, you can incorporate enough of these tools to help but also in many cases looking at things holistically is what will lead to real change and healing. 
  • Visual indicator of your vagus nerve: check your palate!
    • Your left and right side of your palate should be equal.
    • If it’s imbalanced this is a good indicator of potentially other issues within the body.
    • The lower palate side is the diminished vagal side.
    • Check before/after exercise, hard workouts or when doing your vagal tone exercises like gargling or humming.
    • If it’s worse after a hard workout, this could be an indicator of that you pushed yourself a bit too hard.
  • Vocal cords and less range in your voice correlates with poorer vagal tone.
    • Monotone voice as a symptom
    • Ties in with that 3-4% as discussed—techniques that focus on the throat area can help here
  • Tie in with disordered eating and learning to relax with food and meals and not be in a sympathetic revved up state when eating.

Other Related Topics

  • Intermittent fasting—is it really right for the so many people who are doing it these days?
    • More often than not it worsens people’s health—hurts metabolism, hormones, stuck in a sympathetic fight or flight starvation mode…
    • Who SHOULD intermittent fast, a profile:
    • Healthy person who’s ready to adapt to a different/next level of metabolic efficiency/flexibility; must be in a state of health that can sustain and tolerate the bit of stress that IF introduces. 
    • Not someone who’s just skipping meals for other reasons (like being busy, getting nauseous from food), etc. 
    • IF is usually counterintuitive to vagus nerve health.
  • Eating 3-4 hours or 5-6 hours? Different schools of thought:
    • Traditionally adrenal fatigue recovery protocols often recommend eating every 3-4 hours but does this contribute to dysglycemia?
    • Chronic hormonal war by eating too often.
    • Ideally, be able to comfortably go 5-6 hours between feedings. 
  • Blood sugar, continuous glucose monitors (CGM), and technology driven devices.
    • When they make sense; when they’re overboard
    • Another measurement that can be great but how much do we need to be technology driven? (at the cost of learning to be more intuitive).
    • And also sleep apps: What we get from these types of things can go both ways, i.e. it’s not always a good thing but sometimes it can be.
    • How accurate is it all?
    • How much technology do you want in your bedroom?
    • Blood sugar monitors don’t show how much is getting into tissues, and there’s not really a way we can measure that.
    • Blood glucometer gives us just another reading, take into context with the whole person.
    • CGM will show the patterns but not how blood sugar is being utilized.
  • Having hypoglycemic episodes at night and upon waking?
    • Stop keto and IF if you are, which is causing a chronic stress problem
  • Metformin—not all it’s cracked up to be

Take-Homes on Vagal Tone Exercises

  • Breathing*
  • Gargling* 
  • Humming* 
    • *These increases nitric oxide, decreases carbon dioxide sensitivity, increases oxygen, increases GABA to naturally calm down and naturally improves vagal tone
  • Cold immersion with controlled breath
    • Or cold water splash on the face if not one who should do cold water total body immersion
  • The “dose” with vagal tone exercises, breathing exercises—to really improve health issue often you need to do A LOT of work here.
  • Lots of little bits can go a long way toward change, consistently… because often the destress work is often severely lacking.
  • Build off that…


  • Choline – great adrenal nutrient, can help fatigue, of course diet focus first
  • Pantethine (B5) – used to make ATP 
  • Can’t out-supplement a bad diet or overtraining
  • However, more people needing supplements due to stress issues and so on… 

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