Tuesday, February 21, 2006

Go with your gut

"Go with your gut!" That's the advice many of us receive when we are perplexed over a decision. It turns out this familiar admonishment is rooted in physical and neurological fact. You may think with your brain, but you may well make decisions with your gut--in other words, your bowel. I'm referring to the "enteric nervous system," known to anatomists and psychologists alike as "the second brain." The Enteric Nervous System is now getting the attention it deserves in the study of all sorts of vexing medical/psychological conditions such as epilepsy, nervous ulcers and depression.

The Vagus Nerve
No, that's not "vegas" in the gambling sense, but the name of the longest nerve in the body. Vagus means wandering in Latin and that is precisely what the Vagus Nerve does in the body. It's about two feet long, starts in the brainstem, goes down the neck (next to the jugular vein) and into the abdomen. Along the way, it affects the vocal chords, acid content in the stomach, frequency and rhythm of the heartbeat, blood pressure, breathing rate of the lungs, sweating and operation of the bowels. In the brain, it connects to areas believed to be responsible for seizures, mood, appetite, memory and anxiety. Strangely enough, the Vagus Nerve does not have many pain transmitters, a quality that may make it the miracle highway for many sufferers of depression, eating disorders, nervous conditions and even Alzheimer's disease.

The Vagus Nerve is the connection between the central nervous system and the enteric nervous system (ENS). There are, at least, 30 chemicals that transmit instructions in the brain. All of these chemicals are present in the enteric network as well. There is ample evidence that the ENS is not just a collection of relays, receptors and transmitters, but a complex integrated brain in its own right.

The implications of the ENS for diagnostic and therapeutic applications are strong. For example, the brain and the ENS are subject to lesions found in Parkinson's Disease and thought to be identified with Alzeimer's disease. It is conceivable that Alzheimer's disease, so difficult to diagnose in the absence of autopsy data, may some day be routinely identified by rectal biopsy. Hence, the statement that one's bowel is as important as one's brain. The Vagus Nerve is the highway between the abdomen and bowels and the brain. And, the reason we say, intuitively, go with your gut feeling.

VNS Therapy
This is what gets me excited, as a person who has struggled with depression for some twenty years. Researchers have found that a small electrical stimulation of the Vagus Nerve affects mood. They discovered this when using electrical stimulation of the Vagus Nerve to treat epilepsy. Some of the patients, who had suffered from depression, were remarkably improved. After numerous studies, the FDA has approved VNS therapy for the treatment of depression. It involves the implantation of a battery powered Pulse Generator and lead to the Vagus Nerve. It delivers a small electrical charge intermittently on a 24/7 basis for ten years or more.

The FDA agrees the therapy works. Most insurance companies, however, will not cover the implantation procedure and associated costs of VNS therapy. A petition drive is underway to convince health insurers of the efficacy of VNS therapy. For more information, go to: http://www.vagusnervestimulator.com.

There is also a book on the subject: "Out of the Black Hole." That's where I got the idea for this post.

The Stickler

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