Dr. Yori Gidron talks about the Vagus Nerve & HRV (Replay)

[00:00:01] Speaker A: Happy holidays for me, Matt Bennett, and everyone here at Optimal HRV in the heart rate variability podcast over the holidays, we like to do replay episodes. I find that now that we're pushing 200, we're on the other side of 175 now with what we published. Sometimes those old classic episodes where I, I get the honor to interview some of the great thinkers can get lost. It's hard to spend 60 hours to go back and listen to all these, or 175 to go back and listen to all the episodes. So I like to put some of these replays. We know during the holidays you may not listen to as many podcasts, so it's good to put these on. One is just like I want to make sure any new content hit your radar, square on your radar. But it also gives a chance to if you haven't heard, like today's guest Yuri Gidron speak on the Vegas nerve, you need to hear this episode. So it gives me a way to kind of go back and kind of hit my favorite episodes. Episodes I think everybody should listen to. So if it's, you know, if you've listened to it before, it might be just a good refresher. I know I listened to. These old episodes have been great for me as well in my learning curve. And if you haven't listened to it, just assume that it's new. Enjoy Doctor Gidron's expertise. And I know if you're listening to this podcast, you like the Vegas nerve as much as I do. So happy holidays. If you celebrate the holidays, we're wishing you our best. And here's our episode on the Vegas Nerve. Welcome to the Heart Rate Variability podcast. Each week we talk about heart rate variability and how it can be used to improve your overall health and wellness. Please consider the information in this podcast for your informational use and not medical advice. Please see your medical provider to apply any of the strategies outlined in this episode. Heart Rate Variability Podcast is a production of Optimal LLC and optimal HRV. Check us [email protected] dot. Please enjoy the show. Welcome friends to the Heart Rate Variability podcast. I am Matt. I'm back here with my good friend and often co host, Doctor Ina Hazan. Always great to see you. Ina connected us with our very special guest today, Doctor Gidron, coming from us from Israel, which is really exciting. We made all the time zones work out, which is fabulous with this. And Doctor Gidron, just looking at your experience, your research, I'm so excited to have you on the podcast. So I would love to start out just giving a quick introduction of yourself. And maybe what brought you to heart rate variability just in general, before we dig into your research and expertise. [00:02:55] Speaker B: Okay, thank you very much for this invitation, and thank you to my dear friend and colleague, doctor Ina Kazan. I'm from University of Haifa in north of Israel, where the brain of your PC is invented every year. You need to know that not in my university, but in Haifa. I'm a professor of health psychology at the University of Haifa School of Nursing. Actually, I came to this topic in a funny way. I was head of a master's program in health psychology at University of Southampton, England, UK. And in the middle of a course, which is my domain, psychoneurgy. It's sort of like the science of the. The why of the who, the sort of like the mechanisms between stress and disease. So in the middle of a class on cancer, one of these students, Laura Marlowe, who I acknowledged in my first paper, she looks at me and she says to me in her acute british accent, Yuri, why does the brain know that we, how does the brain know that we have cancer? And I looked at her and I said, I don't know. And for about. I put it aside and then I. A few weeks later, I was in the library and I suddenly saw something about the vagal nerve, which I didn't know anything about. And from that moment, for about 50 hours, I did not sleep and I started making connections. She did not propose the vagal nerve. I just stumbled on that paper and then I connected things. And that's my work really is about connecting unconnected issues. And really the domain of psychoneuriminology drives you to make connections between domains across domains and evidence based work. Voila. And then I came up with the vagal nerve. The activity of the vagal nerve is measured by what's called heart rate variability, or HRV. And basically it's the changes in the intervals between pulses. I always say that the vagus is, and it's responsible for that. The vagus is like the accordionist player on the ECG and I see Inan smiling, so it sort of like makes the changes in the width between, you know, narrow, wide, narrow, wide. And the more it's changing, you're actually activating your vagus more and you're actually adapting more. [00:05:10] Speaker A: I love that, by the way. The accordion is a beautiful way to put that out. So I'll credit you, but I might have to steal that one. That's a great one. [00:05:24] Speaker B: Okay. And the more you have, in most diseases, in many, many diseases, the most, the more you have higher heart rate viability, the more changes in those intervals. Actually, your risk of severe diseases like stroke, heart disease were the first ones to show on. Cancer also, and diabetes goes down. And also in many mental diseases, the more you have changes, the less you'll have severe mental disease also, we've shown that it actually predicts longer survival between two to five times more survival in Covid, in cancer and stroke and heart disease. It's crazy. It really is. The evidence is amazing. [00:06:04] Speaker C: Yuri, every time I hear you talk about this, and since the first time I heard you talk about your research, I've been sought out. Other lectures you've done online and read quite a bit of your work and it's incredible how you make these connections. I've been working in the field of heart rebility for 20 some years and the importance of the vagal nerve has not been lost on me. But having heard you talk about just how much the vagal nerve influences pretty much everything, it feels like this magic part of us that we are definitely underutilizing and underestimating its importance. But even, and the fact that the vagal nerve is one of the primary drivers in inflammation, which has been implicated. The inflammation is part of the news. It's talked about as one of the main reasons for your clogged arteries. It's not so much all the eggs you eat, but it's the inflammation that's producing clogged arteries and cardiovascular disease and cancer and all those bad things. Covid certainly all these bad things that kill us. But I honestly did not realize until I heard you just how much the vagal nerve plays a role in inflammation and the ability to reduce it. So I would love to hear you talk a little bit more about that, explain it so eloquently. [00:07:48] Speaker B: So really, what is incredible is thank you for bringing up all of these things ina, is that there's a whole scientific domain called neuroimmunology. So it's the science of the relationship and the b directional influences between the nervous system and the immune system. And this is not taught. It's not taught in medicine worldwide, not taught in biology, not taught in nursing. And you always ask why? Why is it so frightening? I have no idea. I don't have an answer. So already in the 1970s, they discovered that almost all immune cells have receptors for hormones and neurotransmitters. They're not there to decorate a Christmas tree, they're there for neuromodulation of, of t cells, b cells. So obviously, the immune system is influenceable, influenced by neurotransmitters by the nerve system, and vice versa. The vagus is one of the major connectors. The vagus actually tells the brain it's not the only one, but it's the major branch informing the brain about inflammation. And then the vagus and the brain exert two anti inflammatory roots. I won't go into it without visual aids here, but one of them is by the. The stress axis, the hypothalamic pitot, adrenal secreting, cortisol. And cortisol, we know, reduces inflammation. And the other one is via the spleen, certain T cells in spleen. And by these two roots, the vagus modulates inflammation. It's been shown in many studies. I should nominate some people. Kevin Tracy is one of the leaders on this topic in New York. And these are studies that came out in nature and science, and it's not taught. And I just cannot still figure out why. There's a lot of ignorance and just misperception. And probably one of the major reasons why the Vegas predicts lower risk of these diseases or lower risk of mortality is by lower inflammation. We showed this in one study where we, in Brussels, where we showed that the connection between higher heart rate viability and doubling of survival in pancreatic cancer was explained by less inflammation. [00:09:51] Speaker C: Yeah, that's pretty incredible. So, you know, we actually have, you know, right inside us, you know, the ability, you know, very real ability to influence what. What happens to us. And even when something bad is really, you know, is already happening to us, you know, we still have a fair amount of control and ability to make a change. [00:10:12] Speaker B: Right? So part of it is genetic. About 40% to 60% of the. Of the biggest activity is genetic, and some 40% to 60% is about, is environmental. So it's influenced by our lifestyle. Lack of smoking, mediterranean food. You were invited to Israel to eat healthier food in Italy and Lebanon, etcetera, and exercise. All these things increase legal activity, yoga increases. Everything I'm saying is based on evidence. So that's good. It means that there's a window of opportunity for us to influence it. What we don't know enough, and that's what I'm sad, is we know so much that HIV is a predictor of lower risk of diseases. We know so much that HIV predicts longer survival, but we have not done enough studies. There's a big vacuum there showing whether increasing regular activity, does it actually prevent disease, does it actually reduce mortality? And there's more animal research, but not enough on humans. And that's where my research really is right now. [00:11:14] Speaker C: So what are you doing to increase people's heart, your ability? Doing biofeedback. Are you getting people to exercise? What do you think? [00:11:25] Speaker B: So we're doing two things. We're right now running a trial where we're doing biofeedback. So in biofeedback, as you know, you train people to do deep, slow vagal breathing. And you see on a screen, on a computer screen or on a yemenite telephone screen, something that indicates that your HIV is going up. And then you get a feedback that, okay, I'm doing this breathing well. And so we're training people to do that, but we're just running now the study. So we're. And we're hopefully, maybe, maybe going to collaborate with two more countries, India and maybe China, which have a huge number. So it will enable us to get to more people, I hope so that we get more statistical power and also cross cultural, you know, generalizations. These are things and that are important. Another study that were primary, so that's with one of my students with Astaf Gitler. And another study that we're right now starting to do is triggering stimulation of the vagus in the ear. So you can actually stim. There are vagal branches inside the ear, and you can stimulate the ear with a vagal nerve stimulator. So there are several companies that do that. Some of them are american, some of them are british. And this has been shown already to reduce depression, inflammation. This has been shown actually also to reduce depression and other conditions. And we're not testing it on post mi patients. We're about to start doing a study on myocardial infarction. Again, because HIV predicts four times more survival in myocardial infarction, and because some animal studies show that if you activate the vagus soon after a heart attack, you actually reduce damage in the heart. So that's the basis. Matt, you look like you. [00:13:12] Speaker A: Yeah, I feel like I got, like, 20 questions. So the first one I'd love to unpack with you a little bit more is that. That 40% to 60% that is genetic? Like, I don't know. Like, you know, when I think about heart rate variability, we know. I don't know if we can say we have great population norms in HRV anyway, but, like, I. You see huge standard deviations and often that's accredited to genetic factors, I guess. I mean, it makes sense that the vagal nerve. But are we talking about, like, the health or the strength of the accordion player with the vagus? I may be. But I'd love to say, when you think about the genetic aspects of vagal functioning, I'd love to, if I'm asking even the right question, what are some things you see? Genetics could come into play there. [00:14:07] Speaker B: Okay, so I'm not a specialist on this topic. There are people that really know more than this on me. People in the Netherlands, like Nina Cooper and other people. I'm not a specialist on the genetics of this. But what you see is that if I would measure it on 100 people and three of us, and then look at it again over like a few months later, there would be a high correlation between us over time, probably, and that is attributed to some kind of genetic component. On the other hand, it also fluctuates. So when we are in stress, HIV goes down. When we're sleeping, the vagus celebrates, it should increase. When we are resting, it increases. So it has sort of like what we call in psychology a state and trait. So things fluctuate. But also this not fluctuation stays within a certain range across situations in the same person. So that's the genie part. Again, I'm not. I don't want to go into the details so much of the genetic, because I'm not. That's not my specialty. So we should all know. [00:15:20] Speaker A: That does. Yeah. May make sense with what we've talked about on this show in the past with just kind of our set point, kind of that trait thing is genetic in a way that, you know, we always. [00:15:31] Speaker B: Gender differences also, what's important to know is also their age. Age is one of the major factors. Just bad news, downhill. It just goes down with age and dramatically. [00:15:44] Speaker A: Absolutely. So the second piece of what you said in the kind of first question is the. And again, just correct me if I'm maybe not restating this right, but I was fascinated how the bagel nerve, if I heard you right, reacts to inflammation. You know, it creates an anti inflammation because, I mean, I think I always thought about it as if I'm not. If I'm stressed out, the vagal will kind of not have as strong of a break that sympathetic activation goes up and then bad things happen. I didn't know there's kind of a. Maybe a reactive vagal response to inflammation. And I just want to kind of make sure I heard that right. And I'd love to hear. I mean, it's just mind blowing to me that if I'm hearing that right, what that would mean in a lot of different ways and maybe some practical. I mean, obviously the vagal stimulation could be a huge aspect in fighting inflammation. [00:16:56] Speaker B: So during stress, inflammation goes up, but we know that there's a moment to moment connection between the brain and the immune system via the vagus, not only via the vegas, but mostly via the Vegas. And it's sort of like a negative feedback loop. It's like a. It's like the heat going down in your house in the winter, and the thermostat is turning. The heat drops so that you then become less cold. So that's what the vase is doing. It's sort of like a thermostat. It's really the neuroimmunomodulator. It's a modulator of inflammation, and in some people, it's just not working enough. So that neuromodulation of inflammation is not working enough. Those people have low hrv, and then they have more disease risk. It's always difficult to know what I always say, what comes first, the chicken or the nerve. But from longitudinal studies, it's quite clear that the vagal disactivation happens first and then the diseases later. But in some conditions, it's also bidirectional. Having Covid actually reduces vagal activity. Having viruses reduces vaginal activity, and then because of that, probably, although I have to be careful, my terminology, people end up having more inflammation and dying more. So it's been shown in Covid, where there was one study, not ours, but they actually measured in 19 patients in intensive care, inflammation and hrv. And what they found was that the HIV went down before the inflammation went up. Okay. Yeah. So it is quite amazing. I also just want to say, before I forget, I'm belonging to this american association. It's brand new, called HIV I, the Hartford University Institute. And one of the aims of that organization is to, is to. It's a nonprofit organization, is to really spread the word around american hospitals and universities. And we're holding the first HIVi conference on November 30, three O in North Carolina. And it's very important. And the really idea is to bring scholars and to notify universities and hospitals about this, because it's an issue of life and death, in fact. [00:19:18] Speaker A: Absolutely. [00:19:19] Speaker C: It really is. Yeah. There's so much research that is simply unknown. Right. You know, even just, you know, still so many positions disregard her surgeon ability as even being important or, you know, consider it an artificial. And that's just really, really sad. So I'm so happy to hear that. You know, I just want to link. [00:19:43] Speaker B: To what you said, ina. I remember one of the lectures I gave here in Israel, and one of the doctors looked at me. She was really skeptical, very negative. The other two doctors were very open, and she was really negative. And she said to me, it predicts too many things. It's just. I don't know what to do with it. So I said to her, well, that's the evidence. And I said, but age also predicts everything, right? Why are you accepting age but the vagus not? Why is that hard? And then I said, and the good thing is that age, we cannot change, but the vegas you can. So. And she looked at me, and, you know, she didn't know what to say. It was very interesting to see the objection. It's very interesting to see this. And like you said, there's a lot of ignorance and misinformation. [00:20:23] Speaker A: Yeah. Even cardiologists we talk to, like, don't know sometimes about heart rate variability. So that's. I mean, there's just so much space to grow, which is just so exciting as well. [00:20:39] Speaker B: I also wanted just to balance. There are things that we don't know why does not predict. So, for example, in two studies I've done in colon cancer, it does not predict prognosis. We don't know why, particularly in that one. I think that one of the things that we need to know as scientists is that we need to be open when we are right, when we're wrong, and why. So it's not a magic bullet for everything. [00:21:05] Speaker A: So, Ina, I don't know if you got a follow up. [00:21:11] Speaker C: My Internet connection froze for about 30 seconds, what you said. I'm so sorry. [00:21:19] Speaker B: I was saying that there are some situations where it's not predictive, like in colon cancer, and we don't know why. And I think that one of our missions is also to understand its limits. When is it predicting? When is it not? When can we increase it? And does it always help? We're not sure. So that's one of my next directions also to understand more and also maybe use AI, artificial intelligence to increase our capacity of really predicting and preventing diseases. [00:21:50] Speaker C: Well, that makes. Yes, that makes so much sense, because AI can make these connections in some ways even better than the human brain thinking of. We can do the thinking through part, and AI can just process a ton of data and show us how things are. Incredible. I'm also to follow up on that bi directional relationship that you were talking about. We know that age affects vagal activity. I'm also wondering whether early childhood experiences, for example, like, you know, developmental trauma, you know, growing up in difficult environments, you know, you know, adverse events during childhood. You know, how much does that play a role in what our heart revolution does when we get to be adults? [00:22:44] Speaker B: So I'm not sure, I don't have any studies coming up to my mind now, but we know that. We know that several things. First of all, we know that early trauma is associated with post traumatic stress and with chronic pain, and both of these things are related to lower HRV. Okay? So that's important. We also know some very interesting studies from psychiatry that have shown that, because I didn't bring up the third player here, which is the brain, and that's really the interesting part. So, HIV is associated with. With certain brain regions. Some of them are limbic, so like Lamydola, but mostly with frontal regions. And what's amazing is that HIV is associated with the connectivity between these things. And this connectivity is associated with psychiatric conditions, with inflammation, which is amazing, and also with early trauma. In fact, this connectivity is also associated with PTSD. So PTSD patients have lower connectivity between the limbic system, the amygdala and the frontal cortex. And HRV is related to more connectivity. So again, that might be the connection with early trauma or with trauma in general. And one of my other domains is prevention of PTSD, early prevention of PTSD. And we're using vagal activity also as part of that intervention. The other part of the intervention is more psychological, to increase that connectivity actually between amygdala and the cortex verbally by doing it. But whether we can amend that, whether we could change it in people that had early traumas, I do not know. You know, there are a lot of questions and answers. I always say that we progress in science by questions and not by answers. That's my. [00:24:39] Speaker C: That is so true. I have not seen a study that has looked at the people with early trauma and whether increasing HIV activity changes brain reactivity. There was a study, I think it was 2021 Schumann study, where they actually did HIV biofeedback and then looked at brain connectivity, and there was an increase in connectivity between ventromedial, prefrontal cortex and amygdala and insula and several other brain regions. So it seems that if we do biofeedback, we can influence that connectivity within the brain and hopefully then lead to reduction in symptoms of trauma, depression, anxiety and things like that. [00:25:23] Speaker B: This productivity is crucial. There's been one study by meta me h t a, an amazing study where they actually showed that the amount of conductivity in depressed patient between the amygdala and frontal cortex was related not only with less anxiety, but also less inflammation. And guess what? A similar kind of connectivity is correlated with more vagal activity, with more HIV. So these things probably are all related. And now in my work, I'm actually moving to the next floor, to the brain, and that's where we are doing these things. [00:26:00] Speaker C: Awesome. [00:26:01] Speaker A: I had a question about vagal stimulation. It's one of these things that I hear different things about. Yeah, it works, but what you buy on Amazon may not be quite what you really need. Like, I always like to buy a $60 or less device and try it out. I sort of. It's a very fascinating kind of, in some ways, maybe controversial. Some people swear by it, others think it's a ripoff. So you see this back and forth, and I kind of wonder where, where you fall into this, because I think it, in many ways, is it a consumer grade product? Is it something that you think I should be implementing into my routine as a HRV nerd, I'd love to, like, just, you know, I'm always looking for the shortcuts. So if I can stick something in my ear, like just hold up my electric toothbrush to my ear for five minutes in the morning. But let me get your thoughts on this, what you're seeing in your research. And for an HRV nerd that always wants a higher score, you know, what, what would you say to our audience that might be interested in this topic? [00:27:11] Speaker B: So I think. I think it's a very good and legitimate question. I think that, as I said, we know much more about the relationship between HIV and diseases. We know less about what happens when we try to increase it, either by biofeedback or either by a vagal stimulation in the ear, or there's a surgical one, but I'm not going by that one. And there's also an american company that gamma core, electric core that stimulates here in the neck. There are more and more emerging studies on this, but it's still relatively preliminary. So this reduces pain, migraine pain, reduces inflammation. And there have been some early studies showing effects in cardiac patients, but very early stuff. And that's where my research is. And, and there's been studies on depression and probably more. I'm just not fully aware. And there's some reviews on this. But again, I think a lot of these studies lack enough statistical power. There are small sample sizes. Again, these are studies that are not necessarily, you know, drug companies will not fund them, probably, and all that. So we're. So it's hard to run these studies. My supervisor in Canada used to tell me that physics is hard science and clinical research is difficult science. [00:28:34] Speaker A: Yeah. [00:28:34] Speaker B: And there's a lot of truth in that. So you lose patients because they don't want to continue to study and all this. It's really hard. I'm sure that Ina knows what I'm talking to. Do these studies, especially when you're talking about intervention, the side effects are small, so we're talking about minor headaches or a bit of a each year, but we're not talking about majority events. It's relatively safe. But you can always consult with a prediction. You certainly don't want to do it with people who have bradycardia. Some people have low pulse. You want to make sure. And probably other conditions. You might want to always consult with the physician. But again, most physicians don't know about this, so how can it help somebody who doesn't know? I'm sorry I'm saying this. So it really is a multidisciplinary approach. It needs to have several people. I don't know everything. I need to work with other people who are willing to say I also don't know everything. So. And it's not always easy to find these people. [00:29:33] Speaker A: So maybe hold off going on Amazon and buying the cheapest one on the market and focus on my breathing and stretching and those sort of things that. [00:29:43] Speaker B: We, we know, having a healthy lifestyle, doing exercise, doing yoga. And I'm thinking there's evidence on that. There's this study with 59 studies, a review of 59 studies showing that yoga increases Hrdez, especially if it includes slow breathing mediterranean diet. Actually, there's a study showing that every increase in mediterranean diet increases hrv. So eat a lot of salad, vegetables, olive oil, hummus and fish, I suppose, etcetera. And exercise. Just exercise. Moderate exercise. Yeah. [00:30:26] Speaker A: Awesome. Ina, I want to turn over you if you got a question. [00:30:31] Speaker C: Yeah, so I'm switching topic just a little bit, but I would love to hear a little bit more about your recent work with mental health professionals in Ukraine in working with trauma, in obviously a lot of trauma going on over there now. Yeah, I'd love to hear more about that. [00:30:53] Speaker B: Thank you. So I've worked with a group called early starters from Israel, but also with a group from another humanitarian group called Natal in Israel. And we've been twice. Once we were in Poland working with ukrainian refugees, and then recently I was in west Ukraine training psychologists there. So the first one where we actually did for the first time, to my knowledge, we actually opened small within a clinic, a health clinic of Natanz. We opened a 1 meter by 1 meter small place where we actually measured hrv and showed patients with different diseases, all of them linked to low vagal activity, diabetes, heart disease, chronic pain, anxiety and depression, etcetera. We measured their HIV. We told them how to do it. We showed them evidence in each domain that increasing HIV might help. We gave them a little business. Cardinal in Russian now, we would do it in Ukrainian, but it was then in Russian where we showed them how to do deep breathing. And we showed them after three minutes that their hiv went up, their blood pressure went down, their perceived pain and stress went down. And then we said to them, please go home and do it. So this is a non cost treatment and suitable for humanitarian affairs because it doesn't cost anything. And a lot of these refugees already traveled from place to place with their existing diseases. So not only they've been through traumatic events and all that, but some of them had cancer, some of them have heart disease, some of them have diabetes from before, and they're not going to get much medication. So we thought, why don't we give them this as partial, small, minor help until they get full medical treatment? My other work was on PTSD prevention. There's been a terrible, terrible new study showing, I mean, it's a very good study, but horrible news showing that 76%, 76 of the ukrainian population has PTSD. It's an outrageously high number, even if it's 60%. We're talking about large numbers, which is understood. And so we were training ukrainian psychologists with early starters. We were training ukrainian psychologists in PTSD prevention using our method, which is called memory structuring intervention. It's an evidence based, neuroscience based treatment which also includes vagal breathing. So we're teaching them how to do it so that they can go and train and teach other people and treat children in Ukraine. [00:33:34] Speaker C: It's amazing. Can you talk a little bit more about that intervention? [00:33:38] Speaker A: I was going to ask the same thing. [00:33:40] Speaker B: It's been published a long time ago. So the memory structure. Well, I first start with not what not to do. I'm sighing because a lot of mental health still in many countries, not so much in anglo saxon countries, but in a lot of other countries, there's still a horrible, unforgivable gap, maybe of between ten to 40 years between what we know in research and how people are treated in mental health. Really horrible. So it's really, really backwards in many, many countries. Israel is in a very interesting transition, moving from a non evidence based to a very evidence based method of mental health, but still isn't transition. And so studies have shown that debriefing is totally unhelpful. So what is debriefing? Where you. Where you sit in a group or an individual, and you tell people within hours or days after an event, traumatic event, please talk about what happened to you. You legitimize the reactions. It's okay to shake. It's okay to tear. You tell them what is expected, what's called psycho education. In the next few hours, you'll have this, in the next few days, you'll have that. And then there's this emphasis on empathy and support, which we really think is very important and especially emotional expression. But until 1990, nobody ever tested this thing. And then study after study showed it's not working. It's just not preventing PTSD. And worse than that, actually, studies show there's two studies, one in England and one, I don't remember where, that actually causes more PTSD. And then. So what do you do? Everything I'm saying is based on studies. What do we do? So then I started thinking and thinking, and then I started getting more and more information about what's going on in the brain and what might work. So I put together different pieces of evidence, and eventually it was clear that we need to train people to. What we know is that the ones who. Happy Tuesday. End up remembering their event in the limbic system in amygdala, which is very uncontrollable. It pops up and explains the symptoms of PTSD. It's very difficult. As Basil van der Kolk talks about, the body keeps the score, and people who do not develop PTSD process it more in the frontal cortex. And the question is, how do you get from there to there? Obviously, just talking about just getting empathy probably does not do the work. And what we think today is that the secret in mental health is not just emotional expression, but it's about emotional regulation. The vagus is crucial in emotional regulation because it activates the frontal cortex. And certain cognitive strategies, like reappraisal and reframing, help to activate the frontal cortex to regulate emotions. So, basically, we've developed a series of steps. So the person is talking, and every time they say something physical or emotional, I stop them. So they say, I heard this horrible sound, and I say, sorry, can you please detail what kind of sound and why? So the verbaling and the giving causality is frontal. I heard this whistle because there was a missile, doctor, don't you know? And I write down. And then they continue when they say something emotional. I was afraid. I said, sorry, what do you mean? By afraid and why? And they start, I was afraid because I didn't see my daughter. She felt we were afraid. I also note down the order of the things. So if they're very traumatic, they will mix the order. So they will say 15312 in the order of the event. It's part. Now, I repeat to them the story. Boring. Like a journalist. I will say 12345. So it was 07:00. You had coffee with your daughter. You were eating chocolate cake, I don't know, and coffee and tea. And suddenly there was a sound. The sound was very frightening because it's a missile. You were then afraid because you didn't see your daughter, etcetera. I will verbalize their somatic and emotional experiences, give them reasons and put it in order. And then I say to them, please, now you do it that way. And then you start hearing them talking about it like journalists, totally different. And we've also added vagal breathing before and after, so they're very calm. Also in the beginning, and we've shown. We've done already nine randomized trials on this. And in not all, but in most of the studies, the evidence is quite nice. So that's what we've trained psychologists to do. [00:38:39] Speaker C: That's incredible. And do you also measure HRV before and after to see what happens? [00:38:46] Speaker B: Right. We did. In one recent study, we measured hrV, and I'm failing to. We're just writing up the results. I don't think we succeeded to increase HIV, although. No, I think we did. Sorry. I think SDNN went up. So one of the parameters, but I have to double check. I'm just not 100% sure. I've done so many studies on it that I forgot. We're writing up the results now. And in that one, we include kids, and we also added art therapy, so we use drawing to help to restructure the story. Wow. [00:39:21] Speaker C: That'S incredible. And it makes so much sense, given that the prefrontal cortex is depressed. Its activity is depressed at the time of trauma and at the time of trauma recall. If you are increasing the activity of the prefrontal cortex has a better ability to just put on the brakes to amygdala activations and kind of regulates it. Neural pathway, similar to affect labeling. If you give a name to the emotion that you're experiencing, here's the emotion, you give it a name, and the neural pathways in the brain are changing. [00:39:56] Speaker B: Exactly. [00:39:58] Speaker C: Makes so much sense. Sounds so much more possible than, you know, walk me through all the horror you're experiencing. Rather, let's actually reframe it. [00:40:09] Speaker B: So I think that one of the reasons that debriefing is not working for most people is that you're just leaving them with their emotional reactivation and not giving them any regulation. And what am I going to do with all of this? And for so many years we were told that, you know, expressing ourselves is important. Now the idea is not that we should not express, but what do you do with that expression? And that's why you need the emotional regulation and the front activation. I agree with you. [00:40:33] Speaker C: Yeah, yeah. And, you know, bring in HRV and emotion regulation makes a lot more possible. [00:40:38] Speaker B: They go together hand in hand. Totally. [00:40:43] Speaker A: I'm interested. As Israel goes through, it sounds like a transition more to evidence based models of mental health. How are you hoping your work and others can inform Yemenite that? Because, like Stephen Porges is polyvagal theory. You mentioned Vanderkalt. I think we've had this evolving focus on this still, heart rate variability is for early adapters. It's still not mainstream yet, but I'm kind of wondering, is Israel maybe a little smaller sample size than the entire United States? How are you hoping your work and all the great work you've done can help inform that transition, bring that scientific lens, evidence based lens onto this transition? [00:41:31] Speaker B: Thank you for this question. It's not an easy path. It's a struggle. It's a struggle. So I'm not a doctor. I'm not an MD. And I talk to doctors and physicians and biologists, sometimes they think I'm a doctor because my work is very biological. So it's a struggle. Okay. And for a lot of doctors. I'm sorry, I'm going to say something very not nice. It's. The hardest sentences to say is I didn't know that. And that's quite international. So it's hard sometimes. My colleague, clinicians, clinical psychologists. Yeah, but you know, the clinical psychologist. Why are you telling us what to do? So, you know, it's a. So you need to respect, but also show why evidence is so important. And what happens when we're not doing work by evidence based. And I still think that a lot of the training is nothing sinking in, that it should be more evidence based. And what happens, what price as a society we pay when we're treating people without evidence based? And that has to change. So in my country, it's changing a bit slowly, but it's changing. But still, in many countries, it's still way, way, way backwards. It has to change. It's changing there, but it's going very very slowly. And so one of my ways of doing this is by training, is by teaching. And the teaching is really like putting seeds of hope. That's what I think. Yeah, I love that. [00:42:56] Speaker A: Well, let me start to wrap up with one of my favorite questions here, is if you were, with all your experience, all your expertise, like said, I think I just got to the first part of your published papers on this topic, and I think I'd love to explore each of those. So you always have an open invitation to come back. I would love to see it. When you look as being part of this. Few people were talking about heart rate variability 1015 years ago. I think it's more. You talked about a conference coming up. It's getting more in the mainstream. Apple Watch. Fitbits. But yet still, I'd say early adapter stages. As you look ten years into the future, having been part of the history of heart rate variability, what's your best guess? Where do you think we will be? I won't hold you to it, but where do you think we might be ten years from now, having been part of getting us to this point in our understanding of the vagus nerve heart rate variability? [00:44:03] Speaker B: First of all, I don't want to take all the credit. There have been other people you mentioned Porgus, and Gillian Teyr is one of the most important figures and a lot of scholars from worldwide. It's important to mention my dream. I don't want to sound like Martin Luther King. [00:44:21] Speaker A: No, this is it. This is your dream. This is your dream question, my friend. [00:44:25] Speaker B: Go for it. My dream is that it will be more mainstream to measure, just like we measure heart rate and blood pressure, we will measure HIV in hospitals. My dream is that we can start teaching in medical schools and nursing schools and psychology schools about the vagal nerve more because it's really about the vagus is really a psychophysiological agent, and it's an agent of resilience. I didn't talk about that word. And I think that in developing countries like Africa continent, where it's moving from infectious diseases to this is really my vision to non communicable disease, to rich country, rich people, diseases, they don't have the resources that we have in western countries. But activating this bloody nerve is so easy, okay. And measuring it is so easy. And if we could prevent diseases in these countries that have less resources for treating in a rich way these diseases, we might be able to reduce mortality and suffering, and I would really be happy to be part of that. So that's some of my vision. [00:45:40] Speaker A: Awesome. Well, you know, as a shared interest of ours, my work has been in trauma as well. And 20 years ago, when I started to hear about the impact of trauma, very few people are talking about it now. It's like everybody has at least been through two or three classes on trauma, trauma informed care. Recent graduates have had semesters, if not years long classes. So, I mean, as I see this, you know, as a way to measure everything we're talking about with trauma and interventions like yours, like I said, if we want to know these interventions are working, I mean, obviously we've got a lot of research tools, but heart rate variability will hopefully be one way that we can, you know, show that evidence for what is really working. And like you said, one of my, my passions with this, and I know Ina's as well, is how do we make it affordable for everybody? How do, how is this, how is this a device that, you know, if you, you've got a decent smartphone, you can get a lot of the benefits, if not of what we've been talking about today. And I think that's where technology can really help us. Hopefully an AI get us to the masses in a way that it doesn't price people out. And yeah, it's a big challenge in front of us, but it's a great place to be. Awesome. Well, Doctor Gidron, thank you so much. This has been fabulous. Everything Ina said about you came absolutely true. I just want to give you an open invitation to come back anytime you want because I've really enjoyed this conversation. I know our listeners were well. So I'll put a little information about you, your work in the show notes as well. People can find [email protected]. and I just appreciate your time. And there's that old overused saying about standing on the shoulders of giants. But I know you are one of those people that have really informed this movement. And it's always a privilege and an honor to bring your work to our audience as well. [00:47:53] Speaker B: Thank you so much. I'm just one of many. Thank you. [00:47:58] Speaker A: And humble. I find that as a universal trait. [00:48:02] Speaker B: Thank you very much. I wish you all good health. [00:48:05] Speaker C: Thank you. You as well. Thanks.