Empowering Women Chiropractic – Vagal Tone & Neurobiology – Drs. Buerger & Haas

Now, here’s today’s host, Dr. Monika Buerger.

Hello everybody. Welcome to ChiroSecure’s “Look to the Children Show.” I’m your host for today, Dr. Monika Buerger, and I am beyond excited once again to have an amazing, amazing guest. I was so pumped for today. It’s unbelievable. I have the amazing Dr. Amy Haas with us. I have secretly deemed her, the Chiro Nerd Mama.

I love it. I love it.

Thank you for being here. Let me tell the audience about…


…I was a little late on the trigger reading through your bio and stuff, so I was doing that on the way to the office today and I was like, “Oh my gosh. Okay. She’s got a long list of amazing achievements. She’s got a master’s and a PhD in biochemistry, she’s done postgraduate work at Harvard and she had a position there [inaudible 00:01:50] enzymology, which I was like, “Oh, I got to talk to this woman.” We’ll I am going to talk to this woman, I am talking to this woman”, where she coincidentally was in the same building and where she met her chiropractic introduction. Is that correct?


And that was Dr. Steven…

Branson. And there are no coincidence’s in this universe.

No, that’s crazy. She is… likes to put the pieces of puzzle together. So she’s known, we’re going to talk about something she’s known for coming up here in a minute, but her specialty is digging in, finding out the mystery pieces, looking at how we as chiropractors, why we have seen these profound changes all these years and what are the, why can that be happening. She loves to study something that I’ve had a relationship. I joke around that I have a love affair with the vagus nerve, the vestibular system and others. And in fact, years ago I got, I started talking about the vagus nerve about 15 years ago and everybody said, “Oh, that Buerger she just loves to talk about the vagus nerve.” And so now I get to nerd out with my, my Chiro nerd friend here. Anyway, so Dr. [inaudible 00:03:10] she tell you that the microbiome, neuroendocrinology, vagus nerve, heart rate variability. How does that fit into the paradigm of chiropractic? Why do we see it important in chiropractic? She’s a private practice and by the way, happy ninth birthday to your practice.

Thank you.

Had a recent birthday. She has teamed up with Dr. Bruce Steinberg and his lovely bride in something that I’ve got to to check into Chironerds.com. Is that right?

Yep. It’s still in process.

Okay, so it’s in the process so she could maybe elaborate on that a little bit about where she is in the process with that. But anyway, without further ado to the world, Dr, Amy Haas, thank you for being here.

Hi. Thank you for having me.

Did I get your last name right?

Yes. Thank you.

Okay, all right. German?


So, see, I knew we have to be sisters from another mother from another lifetime at some point in time.

There you go. It’s funny three years ago today I was actually in Germany.

Oh awesome. Yes.

It’s my first first trip over there.

Yes. Beautiful country, right?

Yes. Very.

Well thank you for hanging out. I was… When I scored you on the show, I was like big win, big win.

I’m super honored to be here. I’ve been looking forward to this.

So you are known for, I guess with a little expression of “We know”, “What we know”. What is it that you know? What’s your expression, I didn’t get that one right. It’s all connected. Even when…

It’s all connected…

Go on.

“It’s all connected in some way, some of which we know and some of what you don’t know”, did I get that right?

Yes. You bet you.

All right, so tell the world what you mean by that.

You can think of the body as individual parts or you can put it together like a puzzle and think of it as the sum of its parts and the sum of its parts is much more intricate and elaborate than each of the parts independently. And they’re all, the parts of the body are connected in ways. Some we know, some we don’t know. We’re finding new science coming forth about number of different topics. There is a paper that was just discussed last week about the possibility that a stress on bone in mice instigates the adrenal stress response, which was fascinating. Just a couple of years ago, we had the discovery of the CNS lymphatic system and the glymphatic system, and all of a sudden it turns out the appendix actually has a function in the body.

Go figure.


I know, right? So all of these different discoveries about human physiology are still happening and we don’t truly understand all of the puzzle pieces of the human body just yet. I’m not sure we will in our lifetimes. And that’s okay. That’s a beautiful puzzle just to kind of observe and say, not can we control it, but how can we empower it?

Oh, beautiful. Beautiful. Because it’s all network, right? It’s all this networking that happens and I have a feeling you’re a lot like me. You find one piece and then it leads you to a rabbit hole, which now it’s four in the morning and you’re like, okay, I’ve got 20 papers open and I just opened up this huge rabbit hole.

We definitely are soul sisters. Oh yeah.

But I have to ask you a question because, again forgive me, I just got to read this on the way to the office today. You talk about there was a paper plopped on your desk like 10 years ago or something when you, was that when you were at Harvard in regards to the, I call the vagus nerve, the big bad Voodoo Daddy.

That’s a good title. I like that. That’s a really good one.

For those out there…

[inaudible 00:07:09]

I think it said it was… Anyway. Was that the one by Kevin Tracey?

I can find out. Hang on.


Oh, there you go. So tell the world the, the vagus nerve, I call him the big bad Voodoo Daddy because he really, he’s, he is your immune system, I, he is your, vagal tone supports your immune system. He controls a whole [inaudible 00:07:34] anti-inflammatory pathway guys.

Absolutely. Right.

Right. He controls your digestion. He controls your stomach acid balance, your bile, your heart rate. I mean, so this real, this he is really the King of Kahunas.

Can you read that or is it all fuzzy?

I can sort of.

Okay, the sympathetic nerve and integrative interface between two super systems, the brain and the immune system. So interestingly, looking back on this title, the actual problem that I have at the title is that they’re not two separate super systems, they’re one super system, but they have different components that aren’t even mentioned here. This was, oh, this was 19 years ago. This is pharmacology reviews in 2000 and I honestly don’t remember when this landed on my desk, but I know it made me go, wow, I need to look at that and they’re… Rabbit hole.

That is the huge rabbit hole. I remember doing the work for the second edition of the chiropractic pediatric textbook. Anyway, long story and going down this rabbit hole and I then I stumbled about Kevin Tracey’s paper in 1998 and where he saw that the immune system is really modulated by vagal tone and so as chiro… Can we [inaudible 00:08:54] on that a little bit as chiropractors? Now you have done, you did a a study in, or a clinical trial, correct?

It was not a clinical trial. It was just a retrospective case series. I was noticing, I was playing with HRV because I’m a nerd, I play with things and by experimental systems I do not experiment on my patients. I observe them. There’s a difference…

There’s a difference.

…in terms of, yes, in terms of a, what’s that thing you’re supposed to get a some sort of approval to do that. But I’m a born lab rat. I’m not used to working with humans. I’m used to working with test tubes, so this whole working with human subjects is a whole different ball of wax to me. So, I observe my patients and I notice if there’s a trend that a lot of people are showing up at the same finding or the same improvement. And I was noticing that many of my patients would start with a lower heart rate variability as measured by standard deviation of end to end interval and over time that would progressively improve because we know it’s not one data point that is important to understand the direction of health.

You can’t make a trajectory off of one data point. You need at least three data points to make any kind of align and you really want more than that. So I started tracing the heart rate variability in patients pretty frequently just to see what was happening. And it turned out there was a really beautiful commonality between many of the people who were having their subluxations corrected with just conservative care, is their heart rate variability was improving almost linearly and then plateauing and staying there. So I found that very interesting and that’s what the paper’s about.

Oh, beautiful. Where can people dig into that paper?

Now that’s an interesting question. It’s published in the Chiropractic Journal of Australia and I think, you know, there’s some political stuff going on with that journal. So to actually find the article is a bit challenging at this point. So I’m going to recommend that people go to a different resource. It’s Chiro.org, it’s Frank Painter’s site. He does such a fantastic job of looking for different research and putting it into a form that chiropractors can access easily. And so if you search a Chiro.org and heart rate variability, you’ll find a link to the full paper.

Fabulous. Thank you for that. Thank you. And they thank you for doing that. That work.

So, I had sent Alan a few talking points and so forth and he’s like, okay, maybe not everybody out there listening is as nerdy as you and I. So can we…


Could you break down a little bit, let’s give the audience some simple bullet points about heart rate variability, because we want it high not low. So people understand that you want a high heart rate variability, that means you’re adapting better to your stress.


What else do you want to tell them? Just some bullet points for people that might not have heard of this kind of lingo before, but they’re like, that’s intriguing.

So, the first step is to distinguish heart rate versus heart rate variability. Heart rate is 60 beats per minute. Heart rate variability is, do you have beats that are 0.61 milliseconds, 0.62, 0.59, they should be a little bit different, and the distance between adjacent heartbeats. So if you take a five minute sampling of your heart rhythm, your instantaneous heart rhythm, you should be able to use just a simple mathematical equation to standard deviation, to give you an idea of how variable that heart rhythm is. And it turns out that I’m in about, oh, I don’t know, 30,000 [inaudible 00:12:43] references that the variability in your instantaneous heart rate is a reflection of how well your body is perceiving it’s environment, internal and external. Integrating that information and executing a timely, an appropriate adaptive response. Now those were a bunch of words, but what that really means is the safety pin cycle.

So what we’re looking, sorry, go on.

No, go…, well what I want to break down for a lot of people out there that know that I talk a lot about the sensory motor loop and adapting to our external, internal environment. So our external environment are those five FARs senses, sight, smell, sound, so on and so forth. But to our audience’s internal [inaudible 00:13:32] senses, which I believe is, are so profoundly modulated with chiropractic care, is that a [inaudible 00:13:40] proprioceptive that interoceptive, so I just want to throw that in there so we can tie that together for those guys out there. Interoceptive system or neural visceral system is modulated by the vagus nerve, by vagal tone. So this…

Big time.

So this is how we’re linking everything together for you all. So when Amy was talking about adapting to what we perceive, remember it’s adapting to those senses that those senses. So I just want to interject that. So we tie this all together for them.

Perfect. It… One of the paradigms that I use with my patients is your body will only adapt to what it sees. And I’m using the word see in a more general sense, not specifically see, but perceives. If your body does not accurately perceive anything, whether it’s your balance, whether it’s your blood pressure, if your body does not perceive that, it will not execute an appropriate adaptive response to change because of that. So both ends of those loop are really important. And the most important thing is that thing in the middle, the integration place where I think that’s the brain or something.

Something like that.

Yes. Something like that.


Yes, exactly. And so now we also know that there’s… We have these brain regions that [inaudible 00:14:59] it’s like a marriage or relationship, they have to have the chemistry between them and then the constant communication and that communication needs to be, it can’t be one person in the relationship has more say so, more power of a communicator, they have to be communicating, all those regions have to be communicating equally, so that they can perceive their world and respond appropriately in a motor function. So, yes. We could just be here forever right.

I think so. Oh yes. This is awesome.

So, how would we tie this together with the vertebral subluxation with finding, detecting, correcting vertebral subluxations, and what does that have to do with a vagal tone?

I’m going to answer that in a way you don’t expect. So I, do you know Dr. John Chung? He’s in Florida.

Yes, yes, yes. Love him.

Okay. So me too. He and I actually were overlapping at [inaudible 00:15:59] University. He’s part of my brain trust. So basically when John says something, I listen and just today he was talking about a conversation he had with a patient. He posted this on Facebook, that it was a patient returning to care and she wanted to have her vertebral subluxations, her upper cervical subluxation addressed and adjusted and this patient wanted, John said, I think he had a screen show on his overhead computer, something like that. And she said, “Oh, that’s interesting. I wonder what’ll happen when we adjust me.”

So he took a baseline of heart rate variability for this returning patient, did a specific analysis and a specific chiropractic adjustment, and you know John, it’s going to be very specific, it’s [inaudible 00:16:45] and measure the change in heart rate variability afterwards. And there was a very strong trend towards positive improvement. That was instantaneously, it was, there you go for a readout. I mean, and when you look at that in terms of what is heart rate variability, it is perception of the body, integration of information and execution of a response. When that improves, that means that the body is literally adopting better, and when the body is adapting better you can logically conclude that the body will be healthier because lower adaptation is kind of bad.

And that leads to, let’s kind of lay this out by the way John, if you’re listening to this, you’re on my hit list to be on the show. You didn’t know that but…


…you are now, I’ve got my hit list. So anyway, and for the audience out there, this leads to whole downstream neurophysiological consequences because when we’re not adapting appropriately we… We’re stuck in that HPA axis cranking, cortisols kicking, initially cortisol’s anti-inflammatory then it switches to the pro-inflammatory, but there’s a whole cascade of things that happen. So we just want to tie that in there for you out there listening that this is a big deal. This is…

Big time.

…as well as mental health and we know that one in five kiddos in this country is diagnosed with a mental health issue. So I kind of want to transition there if we can for a minute doc. So, okay, let’s break this down. Research… If I were to say, is there substantial research for us as chiropractors to say, I mean we, we know what we see in our offices, we know that we see these responses. But as far as research, if I were to step in a court of law or whatever, [inaudible 00:18:44] Is there research out there to says we definitely affect the vagus nerve?

Whew. Directly or indirectly?

Let’s go with directly first.

I don’t think there’s adequate research yet. I think it will be very straightforward for us to do there are great model systems to follow and I think it is eminently accomplish, and I think that is something that should be on the high priority list for chiropractic research. I actually think it honestly, it’s like shooting ducks in a barrel.


You know, we already know the answer. It’s a matter of how to frame it.

Absolutely. And because that’s always been one of my crazy missions is to, because in your bio, you, I know you’ve done a lot of this work. We have the medical arena looking at vagal nerve stimulators and different modes to stimulate vagal tone and I feel, and I know you’re right there too, I can feel it. We should be on the forefront of being able to tell that to the world and lead that chase and how chiropractic can really modulate vagal tone.

Without question.

Yes, we have all these other entities doing it, you know, and we can innately, we have the power to innately modulate vagal tone and I think, I would just love to see that be the one of the forefronts of where we go.

I would love that and there’s a secondary reason for that. I was thinking about the nature of transcutaneous vagal stem that’s being put forth in the medical device arena these days and you can put an input into the vagus nerve through the trachea’s and you can modulate vagal tone that way and you can measure it. The systems exist to measure what we want to see. But here’s a question for you.

If you decrease sympathetic over activation by sensory input to the vagus nerve, therefore vagus tone is more prevalent, but you have not actually effected parasympathetic. If you’re decreasing sympathetic tone, but, and also you’re not addressing the subluxation, you’re still modulating the system from the outside in. You’re tuning a guitar string the way you think it should be, but that may not actually produce the most harmonious chords.

That’s a beautiful point. Beautiful. Absolutely.

And that’s where we fit, that’s where we have this profound ability at least. Yes, absolutely. So when we talk about little fiddle farts, the little ones, so we know that there’s these critical windows of development. I call it the first thousand days. That’s fetal development, the first two years of life and then the autonomic nervous system. So these critical windows things, there are things we, the nervous system brain expects to happen. They, they need to happen in that time and there’s things that shouldn’t happen. And we know that the autonomic regulation, that vagal tone, heart rate variability comes on board the end of the second try and, and the third try during fetal development. So we need mama to be imbalance and adaptable as best as possible. Where do you see these little fiddle farts fitting into this picture?

Couple of different ways. One is prenatally her mama. Absolutely. And you just reminded me of a friend of mine had a car accident the other day and she’s five months pregnant, so that has some pretty serious implications for making sure that she gets that stress response down for sure. So, prenatally the stress on the mama will be reflected as stress on the baby and that’s literally neurological programming. That’s hard wiring.


That’s hard to fight.


You can do it. It’s hard to fight. And then early on in childhood development, if children are subjected to ACE’s, adverse childhood events, again that will prime their nervous system to have a trigger happy stress response, and that skews the autonomic nervous system towards “fight or flight”, or as compared to “rest and relaxation”. Or if we were talking about Polyvagal theory, it skews the response of the nervous system towards “fight or flight” or “freeze”. And when that happens, you’re setting off an entire endocrine hormone cascade, and we all know that the hormone cascade of stress impacts human health. So if there’s anything that could help to redirect the balance of the autonomic nervous system after these adverse childhood events, then it would be expected to really help the longterm health prognosis of these kids who are having these events.

Absolutely. And in that study they found that the life expectancy of those that, that had the high ACEs score, the average child experiences, their life expectancies to be down by about 20 years.

And there was a strong correlation…

Strong, strong correlation. Just last week I received a recent research paper on positive childhood experiences that will negate, they played off of it off the ACEs study, and that positive childhood experiences will help minimize the expense, the responses of the adverse.

Of course.

So, of course, so think about if we have these little fiddle farts that have this dis-regulation and these adverse experiences and we get into their lives and we can create a positive environment, meaning a positive perception of their environment and be a part of being able to negate the adverse offense, events. That is, I just…

Beyond profound.

Right. And we know that these… This getting, I call it getting stuck in limbic lock and load mode, it shuts down the frontal lobe and then, but this is so much tied to not just physical consequences, but mental health as well, and I really want to hit home to the audience about what we do as chiropractors has a profound effect across the boards in regards to physical and mental health. So anything you want to add to that?

Vagus, vagus, vagus and vagus, but also maybe vagus and possibly vagus.

You think so? Because what happens in Vegas stays in Vegas.

Shouldn’t stay there. Shouldn’t stay there. Oh, I, dang it. I left my iPad in the sun. It was going to give you a title to a paper. But anyways, the neuro, [inaudible 00:25:36] neurovisceral integration model is a proposed hypothesis, top-down appraisal of how heart rate variability reflects the handling of stress in life, as measured by mental health concerns, depression, anxiety, PTSD in particular. And these studies have shown that higher heart rate variability, not too high, because that’s instability. It’s kind of like blood pressure, you want it not too low, not too high. Right in the Goldilocks zone. So higher heart rate variability was, lower heart rate variability was predictive of someone developing PTSD… (Silence) … suppose predictive of is an interesting word to be able to use in a research study.


So heart rate variability as modulated by the vagus nerve and really HRV is a readout.


So we’re looking at vagus function predicting whether someone will end up with a mental health disorder.

And that’s huge. I mean it’s so huge. And again we take it back to our little fiddle farts because this is more of a [inaudible 00:26:46]. But if we start out with this little guy, this little fiddle fart with colloquy, not sleeping, not pooping, right there because that is, so much all the whole GI system’s massively by vagal tone. We’re really getting an outward appearance. I say there a person’s neurological expression, the way they, their outward expression is giving you a window into their neurological integrity. So the [inaudible 00:27:14], non poopy, non sleeping babies after mom has to sit and bounce with them the whole time or whatever. They’re telling us that, “Hey, I’m not being able to adapt to this, this stress that I’m under.”

Absolutely. Yep.

So okay, I can have you here for hours and Alan’s probably like, okay, you guys stop. What is, what is one last, I know you’ve got a million but one last pearl that you want to leave the world with. Not that you’re leaving the world, but leave this audience with?

The distinction between traditional approach to management of the human body versus the above, down, inside out perspective, recognizing that the system truly is connected in ways that we don’t understand or fully appreciate yet, that sometimes it’s better to remove anything that is obstructing the system from rebalancing itself, than to try to fiddle with the system from the outside in, not knowing what’s going to happen. And really that’s what we’re doing with the chiropractic adjustment is we are removing obstructions that are preventing the vagus nerve from doing what it does best, which is modulating and… modulating the body and keeping everything in an active dynamic equilibrium.

Beautiful. Beautiful. Now I hope everybody can listen. Listen to that segment, repeat, rewrite, repeat and be able to articulate that to the world. Because that was beautiful.

Thank you.

So I guess we better wrap it up before we get that, the red flag, but thank you so much for sharing your wisdom, your, I mean, your beauty, your talent and your time with all of us out there in Chiro land. And I look forward to nerding out with you more and you, so Chironerd.com, and then your practice is, your practice website or where they can find your brilliant [inaudible 00:29:19]

Pathoflifechiro.com, I named my practice after a [inaudible 00:29:25], “Two paths diverged in the wood and I took the one less traveled”, and it has made all the difference, so I went from the traditional academic, to where I am right now and I love what I do. I’m so honored and thankful to do what it is that I can people’s lives and to be able to share how these neurons fire and create ideas and stuff with other people who can make use of them.

Well that’s amazing. And I, that’s one of my favorite sayings. So I think we were sisters from another, from another life, from something else, but.

I’m getting that totally.

Again, hey doc, thank you so much and I look forward to your, what you’re coming out with and keep us in the loop. We’ll have…

[crosstalk 00:30:10]

We’ll have to do a round two.

I’d love that. And at some point you and I are going to have to sit down and have coffee and just like nerd out until all of our brains are fried.

Sounds like a plan. Hey God bless you. Thank you for everything you do for chiropractic and just thanks for being you and I appreciate your time.

And thank you for having me and thank you for everything you do for chiropractic.

You’re amazing.

Well, we’re all in this together. My mantra now is “Alone we can make a difference, but together we can make change” and that’s where we need to go.

Love it.

So thank you all out there for tuning in. Make sure that you join Dr. Eric Glocky, the first Thursday of every month. He has an amazing [inaudible 00:30:54] show, and again, Chiro Secure, thank you so much from the bottom of our chiropractic hearts for allowing us to bring this information to the masses and to help serve more children and save more children. So until next month, I will see you the third Thursday of next month.


Today’s pediatric show “Look to the Children” was brought to you by ChiroSecure and the award winning book series “I am a lovable me”. Make sure you join us next week, right here at the same time. See you next week.

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