The Longevity Nerve: The Missing Link in Stress, Aging & Brain Health | Elisabetta Burchi MD

What if one nerve quietly connects your brain to your heart, gut, immune system, and even how long you live? Dr. Elisabetta Burchi explains why the vagus nerve may be the missing link in stress resilience, cognition, and longevity.

CHAPTERS:
0:00 - The vagus nerve and longevity medicine
0:27 - Show intro
1:18 - Welcome Dr. Elisabetta Burchi from Florence
2:04 - Psychiatry, neuroscience, INSEAD MBA
6:25 - Joining Parasym as 4th employee
14:10 - What is the vagus nerve? Neuromodulation 101
18:00 - Autonomic nervous system: sympathetic vs. parasympathetic
20:00 - Fight-or-flight and the modern chronic stress problem
23:22 - Chronic stress as a driver of disease and aging
26:30 - Vagus nerve stimulation as therapy
28:40 - Vagal tone, HRV, and aging
30:36 - Invasive vs. noninvasive VNS
33:00 - How transcutaneous auricular VNS works
34:00 - Published findings: HRV, inflammation, cognition
36:00 - 55+ published clinical trials
36:30 - Cardiovascular, long COVID, fibromyalgia
38:00 - Cognitive enhancement in healthy people
40:00 - How to use it: 30-minute sessions
43:00 - Sleep improvement
45:50 - Athletic recovery and performance anxiety
47:22 - Elisabetta's personal routine
49:56 - The future of neuromodulation
55:00 - Long COVID data
57:00 - Longevity medicine and vagal neuromodulation
58:42 - Closing

REFERENCES:

Parasym / Nurosym Scientific Evidence (50+ Studies):
nurosym.com/scientific-evidence

taVNS Improves Long COVID Symptoms (Frontiers in Neurology, 2024):
PMC11097097

Cholinergic Anti-Inflammatory Pathway (PMC, 2018):
PMC5826620

HRV and Exceptional Longevity (Frontiers, 2020):
PMC7527628

Baseline HRV as Guide to taVNS Response (Translational Psychiatry, 2025):
PMC12689627

GUEST: Dr. Elisabetta Burchi, MD, MBA - Head of Research, Parasym
HOST: Dr. Robert Lufkin MD

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Transcript

Why The Vagus Nerve Matters

SPEAKER_00 0:00

Longevity has uh revolutionized the medicine because it's telling us that no medicine shouldn't just take care of uh of disease, it should take care of health, right? And uh and this tool uh does exactly that.

SPEAKER_01 0:26

Welcome back to the Health Longevity Secrets Show, where we push the limits of human potential and unlock the secrets to our health and longevity with your host, Dr. Robert Lovkin.

SPEAKER_03 0:38

What if one small nerve quietly connects your brain to your heart, gut, immune system, and even how long you live? Today's guest, Dr. Elizabeth Abirchi, explains why the vegan nerve may be the missing link in stress, resilience, cognition, and even longevity. We'll explore how modern neuromodulation is turning ancient biology into a practical tool for restoring balance, improving performance, and taking control of your nervous system without drugs or surgery. You really don't want to miss this one.

SPEAKER_01 1:14

And now, please enjoy this week's episode.

SPEAKER_03 1:18

Hey Elizabeth, welcome to the program, all the way from Florence, Italy.

SPEAKER_00 1:24

That's right. It's pretty late here. I hope you'll be um uh generous with me and uh forgive me for any, you know, lapses or uh forgetfulness.

SPEAKER_03 1:38

Uh no, no, not at all. We appreciate you you making the time to spend with us today. This is this is gonna be a great conversation. I'm so looking forward to learning all about the vagus nerve and autonomic function. It's something we haven't really uh dived in dived into yet with with this audience. So it'll it'll be some some new territory and it and it's a fascinating area. But before we do, your your personal journey spans medicine, psychiatry, neuroscience research, and even an MBA. So that's right. How did all these different worlds come together? And you know, what's what was your journey that led you to where you are today?

SPEAKER_00 2:23

Uh thank you, Robert, first of all, for having invited me. It's a pleasure. And uh well, that's already a difficult question to summarize and give uh you know uh some uh uh logic uh to my journey. Um you know I come from Florence, as you said, so uh I have the renaissance uh in my blood and uh the desire to embrace multiple fields and the interest for complex systems has always been uh embedded in myself. So um when I actually decided to become a doctor, it was um for sure for intellectual uh uh aspirations, you know, to uh to learn about uh the most complex systems of all, uh, which is the human being, uh specifically as I am I became a psychiatrist, uh, the mind-body entity, you know the complex system par excellence, I would say. But um this was combined the intellectual aspiration to embrace this complex system with um with another um um aspiration which has always been uh uh and this is still connected to Florence, which was the cradle of Renaissance of humanismo. Uh so you know, do something that uh could combine intellectual uh uh enticement with uh the possibility to uh to do some good for the people. So that's how I decided to become a doctor. But uh afterwards, uh uh so I completed my studies, um my medical degree and my residency in psychiatry in Florence, and then I moved to the US. I spent a couple of years in New York, um, Assign College of Medicine, where I did some research in neuroscience, and uh where I delved a little bit more into the um the brain, uh the uh and um and I got fascinated about uh um circuit neuroscience because of course the brain, the mind is a complex system, but you can analyze it at multiple levels, right? And uh a recent framework uh which has been promoted by the NIH, by the way, uh in the US, uh, which is uh the RDoc framework, put the circuit level at the center of the multiple levels of analysis through which you can um study uh the brain and its functioning. And uh since uh we we have the circuit level at the center, then my interest towards neuromodulation uh came spontaneously uh as a you know an approach that can directly um analyze and modulate the circuit level. But uh as I said, I've always been interested in complex systems, and I've always had the aspiration of have an impact. Uh, and in order to magnify the impact of my practice as a clinician, I decided to acquire some innovation uh management tools with these aspirations to become maybe an entrepreneur and in any case to act on a more uh systemic level in terms of uh society. So I decided to get an MBA, I came back to Europe, uh, went to INSEEAD business school and got my MBA. And after that, in order to consolidate this new knowledge, even if I was still keeping my clinical practice, which had never left, um I joined Parasim, uh, which is um the company where now I'm um head of research at. And uh I got interested in Parasim because it was uh one of the most interesting at the time when I joined 2021, um MedTech uh Neurotech startup uh startups, and um they were already very uh the company was very small at the time. I was the fourth employee to join. Um but I I felt um I already found uh a very um you know uh strong uh interest in the in the founders for for research and for really also this humanistic uh desire to to create something that could have uh improved the health of the majority of people possible. And so I I joined the company and in these years we have done a lot of work, we have uh uh published a lot of uh clinical studies, uh, gathered a lot of uh interesting data. Maybe we can we can discuss a little bit. And uh yes, I didn't mention the vagus nerve yet, but um we are uh now, we are nowadays we are uh the leaders in the field of uh transacular vagus nerve stimulation. So maybe we can later uh uh say something more about uh about this technique and this technology.

SPEAKER_03 7:58

Yeah, I want to be well before I want to dive into the vagus nerve and then specifically talk about uh parasym and neurosim, the the the work you're doing there. But before we do, I'm just curious to tell us a little bit about the since you since you had educational training and work both in Italy and then in the US, what what what what were the cultural or educational differences you experienced in those places?

SPEAKER_00 8:26

Oh let me think. So um maybe I'm an optimistic by nature, so I've enjoyed both systems, and uh I maybe I was lucky enough to to um to find the right people because it's always about people. Uh even if there are some uh we have talked about have used this word many times, systems. There are some systems that drive sometimes behavior, but I believe that people always make the difference. Um but in terms of attitudes and maybe environments, I I can say that in the US for sure um is renowned that there is more, there were more funds uh available for doing research. Uh but um I can say maybe I got the best because uh I did my you know my uh in Italy the the the education system is uh has always been uh thought to be very good for the first uh um initial uh uh educational levels, such as you know, from the elementary school, there's always been very, very good because we have this uh um tendency to um to be holistic. So uh once you need to uh get uh you know the background, the foundations, we are very good in these things. Uh while I found that the Anglo-Saxon systems is very good in uh you know um in the specializations in the um uh detail-oriented uh um researcher, no. So since I I got my no fellowships in the US, I was already at that level. So uh it was very good. But um I uh the the money, yes, it's uh it was another factor. Um there were some differences in the in the way people interact. Um so I think uh uh in Italy we are more less formal, and uh relationships tend to be authentic uh in each and every environment, you know, at work, in school, um but especially in the working environment, I felt the difference in the US. It happened once that I put a hand on the shoulder of a colleague because we are very we we gesticulate a lot in Italy, you know, and I'm very much Italian. And I it happened that I touched his shoulder and he told me not to do it again, never again, because and I was a little bit shocked to be honest with you. And uh but uh so I thought uh uh despite the politeness, you know, the politeness that you can breathe much more with a very polite environment, but there was this uh um this discrepancy in my perspective, you know. Uh because for me being polite means also being close, uh genuinely close, you know and uh touching is part of this. So uh that was a difference I found, uh, not related to medicine or anything, probably if I was uh uh in a totally different environment, but working environment in the US would have been the same. Um but I could say many many more things, like the meritocratical aspects. Uh um in the in the US, uh I think there is this uh capability in the educational system to push and foster the uh talents and capabilities of the of the students, you know, uh, so that they can also um this is reflected at the university level where you can compose your degrees, you know, you can choose uh which uh courses you can follow. In Italy is much more um structured, even at the university level. And uh you know, it's the the various uh um schools are divided in a different way. Uh university starts at 19-20 years old, and till then up to that age you are at uh liceo uh or other kind of uh um mid school, let's say non-middle school, how do you call this? Um before university you have college, right? High school, and before high school, yeah. And we have uh a long high school uh where the the the you know the um what you have to study is already decided. Uh you you don't have much uh room to uh to create your own path, so it's more rigid. And I would have liked to probably to I would have enjoyed college uh in the US, but it's fine.

Vagus Nerve And Autonomic Basics

SPEAKER_03 13:54

Well, hopefully, by by being able to experience both systems, you're able to take the best of both worlds, maybe, and then bring them back with you and I I like to think uh that this was the case. Yeah, well now so let's let's dive in. So for our listeners who are who are new to this, what exactly is the vagus nerve and why does it place act as such a critical hub for our autonomic nervous system? And what is our autonomic nervous system, also? So let's do uh neuromodulation 101.

SPEAKER_00 14:30

Let's try. So the vagus nerve. The vagus nerve is the longest and most spread uh nerve and cranial nerve because now it starts from the brain, uh of the body. So already now the the length and the and the um diffusion of the nerve in the body tells you about the importance of this nerve. And in a way, we could say that uh the various nerve in the quintessence uh represents the quintessence of what the nervous system does as a whole, because uh it links the brain with the major internal organs of the body in a bionivocal fashion. And why why do I say that this represents the quintessence of the function of the nervous system? Because the nervous system uh, of course, is a collection of organs, uh, but uh with a specific function which is um trying to gather information from the external environment and the internal environment in order to activate and to coordinate the other systems in the body to um maintain homeostasis of the body itself. So um the vagus nerve does exactly that internally. So it's it does represent this function within the body. Um it's mainly a sensitive nerve. So uh I said that it bionivocally links the brain with the peripheral organs, such as the gut, the heart, the lungs, etc., uh, with the brain. But it does that in a bioniferal fashion, but mainly it gathers information from the peripheral organs, um, in order to gauge the no if the myostasis is maintained. Uh and the nervous system as a whole does this uh also gathering information from the external environment and then prompting responses in the body, um modulating the function of the cardiovascular system, the respiratory system, genus urinary system, gastrointestinal system, narrow immune system, uh in order to maintain balance in the body, and so to um this is uh the what evolution has uh selected for us to to thrive in this environment. Um and the nerve the the vagus nerve is part of the autonomic nervous system, which is a branch of the nervous system which does all this uh orchestration of uh gathering of information and promoting responses uh in the body uh in an unconscious way, let's say. Um so that's the autonomic nervous system. Autonomic comes from uh this uh um way of functioning that doesn't require consciousness, awareness. Um, and is composed by two branches itself called the sympathetic and parasympathetic nervous system, and the vagus nerve uh represents um constitutes the the parasympathetic nervous system. It carries 75% around of the fibers of the parasympathetic nervous system. So um we can say something more about um what these two branches do, if you if you think it can be helpful for our conversation. Um, but so we I think we have we start perceiving why the vagus nerve is important.

SPEAKER_03 18:43

Um so it the vagus nerve is involved with the autonomic nervous system, which regulates our body's responses unconsciously, and it's the the the two divisions, the sympathetic, autonomic nervous system, and the parasympathetic. And the vagus nerve is a majority of the parasympathetic nervous system. Now, talk what is the what is the parasympathetic nervous system? How does that how does that appear normal and how does it go become abnormal and dysfunctional? And what does that appear like?

Stress Physiology And Chronic Costs

SPEAKER_00 19:17

Yes. So the parasympathetic nervous system is that branch, how can we see if it functions normally? So is that branch of the astronomic nervous system that regulates the so-called rest and digest response? Uh so of course there is always a balance in a in a healthy state. We expect a balance between the sympathetic and the parasympathetic. And this balance is dynamic and depends on the challenges that the body encounters. When I talked a little bit about the function of the nervous system as a whole, I was mentioning about maintaining balance and maintaining homeostasis. This makes us think about something that disrupts this balance, right? That something that disrupts balance uh is what we call the in layman language, but also uh in uh in a proper with the proper terminology stress, actually stressors. So stressors are those uh challenges, those stimuli that tend to disrupt homeostasis in the body, right? And uh what generally happens uh in uh in uh what we expect physiologically to happen in the body is that the sympathetic nervous system activates the body in an orchestrated fashion with the so-called fight or flight response, uh, which stands for stress response. So we talked about stressors, and the stress response is that court of physiological, psychological, I would say, and biological, and also behavioral responses that the sympathetic nervous system triggers in order to restore balance. After this response, which is characterized generally by you know increased increasing rate, increased in respiratory rate, mobilization of um of energy resources. This uh phase is generally then restored by the parasympathetic nervous system that kicks in afterwards when the challenges uh the challenge or the stimulus is uh put under control in order to restore a normal balance. So with the heart rate decreases, uh now the respiratory rate decreases as well, and the body. Is ready not to fight anymore, but to is capable finally, eventually, to rest and digest, no, because of course we want to digest when there are no um ongoing challenges around, you know if we think about the prototypical situation of um a human being in the savannah in front of a real challenge, because that's the tricky point. Uh, sometimes the sympathetic nervous system uh activates itself even if the challenge is not real but just perceived, and that's a critical point in our contemporary society uh where you know um there are a lot of demands and the the the um and the the the bodies put under pressure even if there are no real challenges, uh the the the challenges that we might think uh if we think about uh survival, no? So, but that's the general uh flow of the the dynamics in the functioning of the autonomic nervous system. So the parasympathetic has this key role in rebalancing and restoring the body after a challenge. So, and I talked a little bit about stress, no, um given the topic of your the overarching topic of your podcast about longevity, no, I think that the vagus nerve and the parasympathetic nervous system functioning uh and stress are relevant topics for uh for living a long and healthy life. So um I think that but you are the expert in this, I think that longevity strategies uh might have um neglected a little bit the importance um of managing stress in order to improve longevity in the population, no, uh because it's always been an elusive factor, no. It was also difficult to uh to define it because there are multiple definitions of this concept, no. But if we think about there is a psychological, for instance, definition of stress which comes from a theory the field of uh coping strategies, etc. But we we try to not define it in a biological way as this um set of coordinated responses triggered by the autonomic nervous system when a challenge is perceived. Um and we know that when this phenomenon, this response becomes chronic, for instance, there are many consequences in the long term in terms of health outcomes. So um there is um if you look in the we look up in the literature, uh lot of evidence pointing to the to stress, chronic stress as a key factor in terms of health outcomes, chronic conditions, mediated by, of course, by um increased risks in metabolic cardiovascular conditions, um, mental disorders, and and of course, also um also well-being as a whole because there is a subjective uh the subjective um feelings of being stressed, which is not pleasant, clearly. Um so that's that's that's why I think talking about stress and the vagus nerve is uh pretty relevant uh within this uh um this uh this podcast and uh what you are generally talking about.

SPEAKER_03 26:33

So let me uh let me summarize then if I if I understand correctly, then stress is a part of our modern world, and it is uh we're constant the the notion of chronic stress is a driver for a number of diseases. It's harmful to be under stress all the time that's mediated by one arm of the autonomic nervous system, the sympathetic. And now we're talking about the parasympathetic nervous system, the most of it coming through the vagus, and that acts to decrease stress and reset it. So, this is a target for therapy that if we I guess we'll talk about this in a minute, we stimulate the vagus nerve, we can stimulate the autonomic nervous system. And what it does is it resets the stress response, lowers the stress, and presumably improves our metabolic health outcomes and other outcomes. Now, there's there's growing research using using uh vagus nerve stimulation for stress, inflammation, cardiovascular outcomes. What are some of the most compelling findings that that you you would point to?

Tracking Results With HRV And Sleep

SPEAKER_00 27:42

Yeah, great summary because sometimes I lose myself in voice. So uh that's absolutely right. And uh stimulating the vagus nerve is one of the most promising approach uh approaches to rebalance the whole system towards the parasympathetic, the vagal tone, which tends to be the arm that is more fragile in the balance, because this is very important to highlight, because people might think, okay, yes, uh we could have dysautonomia, an imbalanced autonomic nervous system, sometimes on the parasympathetic side, sometimes on the sympathetic side. This tends not to be the case. So, generally speaking, is the vagal tone that tends to decrease. Uh, there is an association between aging and low vagal tone indexed by um high rate variability, which is an index that my people, many people might be aware of because it's uh used by a lot of these uh uh smart watches, for instance, because it's being recognized as a very important uh marker of uh good health. So high rate variability measures basically the difference between different bits. So if this difference is not always the same, it means that the heart uh adapts to the to the needs of the body that changes over time. And if uh your cardiovascular system is adaptive and is capable of doing this, uh it means that uh it is in good health. And if this is true, this high rate variability increases. So this high rate variability is given by the vagaltone. Uh and we have seen that with aging, this high rate variability tends to decrease, and this is also associated with an increase with a poorer health outcome, and we know that aging is the major risk factor for morbility and morbidity. Um and so that needs to be clarified, no. So the autonomic nervous system tends to be disrupted mainly mostly on the parasympathetic side. Um there we can think about theoretically multiple ways to try to rebalance and to increase the vagal tone. One of the most promising is given by neuromodulation and uh by um a category of neuromodulation techniques, which is which uh this category is called vagus nerve stimulation, which started as an invasive uh technique, um which was approved uh in the past for treating resistant depression, for instance, or epilepsy, and epilepsy. Uh but in the most recent years uh we developed a way, we discovered a way to um to stimulate this nerve not requiring any surgery. And uh we can do this through two different approaches: one is cervical and one is auricular. Um our approach is auricular, it's transacular, um which uh I would like to claim as the most uh uh as the best approach between the two because of anatomical reasons. Uh in the cervical area, there are multiple different uh entities uh besides the cervical branch of the vagus nerve, which is an afferent and afferent branch, which means that drives information towards the periphery and the brain, while at the at the auricular level we have the auricular branch of the vagus nerve, which is just an afferent branch. What does it mean? The stimulation of this branch carries directly the um the stimulation of the brainstem without affecting directly the peripheral organs, and this is a safety measure. Uh the other advantage, the other anatomical advantage of um reaching the vagus nerve through the ear, is that uh uh, as I said, the risk of target effects is lower because um you can stimulate the auricular branch of the vagus nerve and not other and not other things, while on the cervical level is much more complex. So that's a little bit no um just to summarize what the what the options are. Um we have stimulated, we have developed um uh technique so that we can stimulate this branch through the tragus of the ear. Um and we stimulate through electrical stimuli, so talking the same language of the vagus nerve, the auricular branch of the vagus nerve, then carries the information, the stimulation um at the brainstem where there are multiple nuclei of the vagus nerve, and from there we can have we we have shown to uh to have multiple downstream effects, central effects, and peripheral. Um as I said, uh I mentioned HRV, which is and now we uh which is a marker of uh the vagaltone, we have shown to improve significantly uh HRV in both healthy populations and clinical populations. Um we have shown talking about um pathophysiology or physiology, so mentioned HRV, we have shown to improve bioreflex sensitivity, uh, we have shown to improve inflammation, uh decreasing inflammatory cytokines such as uh TNF alpha, interlecine one or six in multiple clinical populations. Uh, because I didn't mention when we were talking about the stress response that, of course, inflammation is involved uh in the stress response. And so we and it's it's mainly involved when we talk about chronic stress response. So we have shown to modulate uh the immune system through the cholinergic um pathway, which is a pathway um of the vagous nerve that goes to the spleen. So we have shown to decrease peripheral levels of inflammatory cytokines. And uh and regarding the central pathway, we have uh we have shown in uh published clinical trials. I mentioned we have published more we have completed and published uh many clinical trials, more than 55 so far. And when we say we, I don't mean I don't mean our company, because these are independent studies conducted by uh academicians in um across the US, mainly and and Europe. Um studies conducted by these independent researchers using our technology. That's why I say we have published, but we we have given the technology, so um they have published the studies. Um and so talking about the central pathway, so stimulation through the locus cereuleus, uh, activation of stimulation, modulation of subcartical areas and cortical areas. Um we have seen effects in terms of uh multiple cognitive functions, um, such as memory, attention, for instance. Um, and so we the the possibility to drive to leverage this technology in the clinical space are really multifold because of the of the anatomy and the physiology of the vagus nerve, which really uh is involved in many many processes. So um in the clinical space, we have published across the cardiovascular space um postviral syndromes, uh functional conditions such as fibromyalgia, but we also have uh plethora up data in um in healthy people. So um because as I said, uh in truth, our uh even if we do not have any particular conditions, we tend to have a low vagal tone because of the um it's a complicated uh I have some hypothesis why the vagus and the parasympathy nervous system is more prone to be um uh deras, let's say. Um if you are interested, maybe we can discuss more, but that's the case. But also in patients and people that do not have any clinical conditions, we can uh we can foster uh cognitive capabilities, and we have seen that. So, improving, for instance, memory retention and reading comprehension during uh specific tasks. We have compared uh the use of uh the the researchers are compared, you know, the the uh the efficiency in um in conducting certain cognitive tasks, and they have seen how uh auricular vagal nerve nerve modulation therapy through parasim could really improve uh uh cognitive capabilities and otherwise healthy people. So, yes, that's a little bit um yeah, no, no, that's great.

SPEAKER_03 38:12

Let me let me summarize then. So the Parasim, the device that your company makes, it's it attaches, it literally attaches to the tragus, which is the earlobe here, and it it attaches like this. Um, and uh like you've got one there.

SPEAKER_00 38:30

I've I have one at home like and uh that's the Neurosim, it's the European version, but in the US it's called uh we have launched uh last year, 2025 at this point, um um a device specifically for the US market, which has a different name, it's called Neuropod. It looks very similar to the Neurosim. And uh yes, you you have the earpiece. Um this is very this has been designed for at home use, so it's really accessible and easy to use for everybody. It of course it comes with a booklet with information how to know how to set it up, but it's very easy. And this earpiece you put uh now. I have my my earphones, but um you you plug it at the tragus of the here, yeah. Oh, the tragus, yeah. Not to the lobe, but to the tragus. The tragus, yes.

SPEAKER_03 39:30

Um and and so this is it obviously it's for certain clinical conditions that you know your doctor may prescribe it for you, but you're saying it's also for kind of well-being for all of us because we all we all have stress in our lives. So if I'm if I'm using this and it's you know, I've I've tried it, it's very comfortable, it's not uncomfortable at all. It's a mild tingling situation. I understand, you know, I use it for let's say 30 minutes a day. Um uh what kind of response should someone look for? Like an average person, like, should I track my heart rate variability? Would I expect to see that go up if it's functioning well, or what what sort of biomarkers or indicators, how do we know that it's working?

SPEAKER_00 40:21

You mentioned one which is very meaningful, HRV, absolutely. We have shown already in multiple trials to that our technology is capable of increasing high-rate variability. So that's for sure something you can track over time. You need to take into account one uh one point, which is that clearly baseline conditions matter. Uh, what do I mean? That there are certain people, and talking about average people with no clinical conditions, um, they might respond better than others. And this is based on certain characteristics. We have already identified some characteristics that might um foresee a better response. Uh, for instance, a low baseline high-rate variability predicts a better response. How about somebody that is highly highly trained already with top HRV in that regard, in terms of improving HRV, which is very noise, right? Very intuitive. This is also true for stress reactivity, which is you know the uh the tendency, uh the tendency of uh reacting in a certain magnitude to a stimulus. No, people that have higher stress reactivity. This is a recent finding. Um, we are gonna publish soon uh a study uh in uh in a work environment we have uh where we have shown that uh use of uh parasymptology could actually improve uh performance, worse performance, mediated by an improvement in, for instance, stress reactivity. And uh what we saw was that people with a higher stress reactivity at baseline responded better and had a better response, better benefit, a greater benefit now compared to the other ones. So there are certain uh characteristics that might predict a better response. But as you said, as an average person um that is uh um let's say works uh no and lives in an urban center, no, knows the environment, uh, constantly simulated uh digital overflow of information. Uh I think that uh 30 minutes uh times two could be now an average protocol. Um and following circadian rhythms, uh better outcomes are foreseen if we have this stimulation, these sessions with the device in the morning and at night might be a good protocol. And we could measure HRV over time in order to over time. Actually, we have seen improvement in just five minutes of stimulation, but of course, improvements and benefits piled up over time. So this has been designed for chronic use, let's say, you know. Uh then we have published studies in which the protocol was very short, others was a little bit longer, but it depends what we want to achieve clearly. But let's say an average protocol, one month of stimulation, daily stimulation, 30 minutes, one hour a day. That's an average protocol. I didn't mention earlier another thing. We might all be interested in uh in terms of improvement, could be sleep. So uh we have published many studies in which uh um uh sleep quality and quantity are subjectively reported, and this is the top set to another thing I wanted to mention. So, what do we need to track in order to see if it's functioning? Let's not neglect the subjective aspect. No, uh if I feel better, this matters, no, it's not uh uh is not irrelevant. So, for instance, um if we would like to improve our sleep quality and quantity as well, you might use it before going to bed in order to you know to foster uh to boost the transition between the an awake state to the sleep state and the vagus nerve, the parasympathetic nervous system is involved in this transition. This could be a new case that almost everyone could be interested in. And uh and yes, I could track my lip with this, with the no smart watches, for instance, even if we know that smartwatches or uh those are not clinical grade um tools, so we always need to take the results with a little bit of grain of sauce, uh but tendentially, and then there is the subjective aspects. No, if I feel that uh that will tell me something. Um yes, this is uh I was thinking about many other uh potential use cases now for healthy populations, no average population. Uh another use case is in related to recovery after uh stressful situation, physical stressful situation. What I'm talking about is sport, no training. Training and sports are stressful situations, right? And uh we have a lot of elite athletes that are using Arasyn technology, neuropod, in order to uh foster recovery after training. Um after usual training or after performances, uh but also before uh the performance, because sometimes you know there are people with high stress reactivity or with performance anxiety, which might benefit of decrease in the in the alertness, no, uh that is triggered before the performance uh requested and demanded. So another use case is um in athletes, uh in order to increase the speed of the recovery after uh the session or before a performance. So um this is another, it's another declination of stress, you know, because as I said, also training is a sort of stress.

Focus Routines And ADHD Traits

SPEAKER_03 47:20

Yeah, well, as a I have to ask, as an expert in the field, um, what what's your personal practice or daily routine around uh nervous system regulation? Is this something you do yourself every day, or is it something that you need just before a stressful podcast?

SPEAKER_00 47:37

Or uh no, I should have done it. Uh no, it's not stressful, it's not stressful, but um I could have been a little bit more synthetic in certain uh but you'll forgive me. You already gave me your forgiveness at the beginning, so uh my routine. I um I I thought about authenticity, Italian authenticity, so I'm gonna be authentic. I'm a little bit, I have a little bit of a DHD. Uh more than a little bit. So uh there is a mechanistic rationale. We we are also studying uh the effectiveness of our approach in a DHD. Uh we have not published anything yet so far, uh, even if we even if we have shown to improve attention in different clinical populations. So I like to, and there is the mechanistic rationale because, as I said, uh, there is a connection between the nucleus uh uh tractus solitaris of the vagus nerve with the locus ceruleus, which is uh one of the main um nuclei in the brainstem which produces noradrenaline, which is involved in attention, no. So we believe that this can be very, very effective in people with uh uh with the DHD traits or features in terms of disattention, etc. So I like to use it when I have to do some deep work, you know? So to help me concentrate and focus. So that's one of my favorite use cases. Um and being a very dynamic person, I like also to use it before going to bed, uh while I'm in bed, uh potentially putting my my phone aside, which is uh not very disruptive, and uh try instead to do this, yes.

Where Neuromodulation Goes Next

SPEAKER_03 49:37

Uh well well looking looking forward to the future, where where do you hope or see neuromodulation and parasim will be five years from now in both both research and real-world impact? What what can we look forward to?

SPEAKER_00 49:56

So for sure neuromodulation uh as a uh as a treatment approach in general uh is rising. Uh and um in the near future I see um more and more clinicians resorting to this treatment strategy, uh which is very complementary to the pharmacotherapy or now as a psychiatrist, behavioral therapy, psychotherapy. Um and the it's complementary and uh it fills the gaps of some of the other approaches in a certain way. Uh, because uh thinking about the circuit level, I mentioned when I was talking about my interest for psychiatry and the study of the brain and mental disorders, etc. If the circuit level is the central level for the analysis of the brain and the understanding of the brain, then neuromodulation becomes the privileged uh strategy to investigate and modulate the nervous system, right? And neuromodulation does this in a way that is time and space specific, what is very difficult for pharmacotherapy to do, right? So it's very complementary in this way. Um then if I'm thinking about our technology specifically, this is truly accessible in cost, I would say, for the refinement of the technology and for you know for the um lifetime uh uh durability also. Um but it's also accessible because of its easiness of use. Um there is another important aspect which is the empoweredness. I like to think about health as um, you know, um, if we think about the relationship between the doctor and the patient, you know, uh it's always been a little bit uh umbalanced, you know. Uh the doctor knows the knowledge, and uh no, and the patients uh and the and the doctor downloads the knowledge to the patient, sometimes not even explaining how things work, right? Um this is changing, uh this is changing even because everybody has access to the web, and uh even it's very confusionary, and uh the difference between reality and fiction is becoming blurred more and more, but that's another story, no. But gladly, uh a good down the size effect, a good um effect of this is that uh no this relationship is changing. But I like to think about health as a um as an endeavor that both the patient and the doctor uh um achieve together. And uh besides the the the doctor's office, beyond that, uh I think about uh people uh empowered to take care of their own health uh on a routine fashion, in a routine fashion and a daily basis, and for sure um a tool such as this one uh put health back in the hands of the patients of the people, no, because uh if you think about the use case, for instance, towards uh managing stress and stress reactivity, uh the the user uh is the um encouraged to listen more to himself or herself, no, to understand his needs, to understand uh, you know, like in a neurofeedback fashion, you know. I feel that I'm more stressed. Maybe I need to calm down, maybe I need to use a little bit of neuropod, you know, but uh the empowerment is is in both sides, in both directions, no, in understanding what I'm needing, what I need right now, and I'm doing something for um satisfying this need. So I uh I think that these characteristics are pretty unique in the in the medicine space and the medicine treatment uh alternatives. So this could definitely make this uh technology successful and uh grow in in the use now uh in the population. Um we have a lot of clinical trials ongoing, uh maybe more than the ones we have already completed uh in the multiple fields, and maybe I'm not sure I can uh I can uh uh share information about things that have not been released yet. Um, but we have in store a lot of um improvements to the technology itself, trying to put together the stimulation with the you know with the measurements. Uh you were telling you you were asking me about the biomarkers, so we are working on this, we are working on objective um ways of measuring uh the effects of the treatments. Um so we are currently modulating, but we could potentially also do something more. Um and uh and then we'll be at that point the technology will really be complete. Um cannot say much more, but we are uh we are close to to develop even more this uh this uh intelligent tool. Um and yes, and then maybe another thing is that uh I would like to add is that uh um this kind of approach um overcomes the limits, the boundaries of medicine as was intended in the past, as uh you know the science that treated the diseases, conditions. Uh longevity has uh revolutionized the medicine because it's telling us that no medicine shouldn't just take care of uh of disease, it should take care of health, right? And uh and this tool uh does exactly that, as we said, as we have seen a little bit together, you know, it can be used for certain clinical conditions, and we didn't even touch upon too much upon the data, on the data that we have gathered, for instance, in long COVID, which was such an unmet clinical need, then we have published more than we have published three studies in long COVID, all positive studies, showing how um AVNT, which is the acrony we we have marked for our uh treatment approach, uh auricular bagal neuromodulation therapy, uh could uh ameliorate a lot of uh clinical symptoms, um characteristics of the of uh long COVID, uh such as fatigue, for instance, depressive symptoms, anxiety, gastrointestinal symptoms, brain fog, etc. So can be used in clinical conditions, but can also be used to enhance health. So I think that this is really the most appropriate, adequate approach for a longevity doctor because now it embraces the treatment, preventative medicine, and uh promotion of health.

Closing Thoughts And Announcements

SPEAKER_03 58:40

So many so many things to look forward to, such an exciting uh such an exciting future for uh for us all with this technology. Well, thank you so much, Elizabeth. This has been a wonderful conversation, and uh we'll put links to you and the company down in the show notes. But uh I want to thank you again for taking time to be with us today.

SPEAKER_00 59:03

It's been a pleasure for me. Thank you so much for asking me.

SPEAKER_03 59:08

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SPEAKER_02 1:00:28

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