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Thursday, June 13, 2024

Unlocking the Energy of Your Vagus Nerve


The vagus nerve is concerned in almost each physiological motion within the human physique and harnessing its energy can have a right away and dramatic impression in your well-being.

Metaphors abound for the vagus nerve: 

  •  The superhighway of your physique, transporting very important data between your mind and the remainder of your inside organs; 
  •  A symphony conductor, directing how briskly or sluggish, loud or quiet your nervous system shall be at any given time; 
  • Air visitors management, monitoring a mess of shifting components to ensure the entire physiological airplanes fly safely and effectively to their vacation spot. 

In a time after we all communicate the common language of hyperbole, it could be straightforward to dismiss this vagus discuss as simply one other passing development from a wellness tradition that promotes and discards the subsequent! large! factor! for sport. (Actually.) 

However, right here’s the deal. Physicians way back to the Roman Empire1 have been grappling with how the vagus nerve impacts bodily perform. We’ve now discovered that easy motion and breath workouts may be accomplished at residence to manually stimulate the vagus nerve in occasions of stress to set off the physique’s pure rest response. And for sufferers with situations starting from epilepsy to rheumatoid arthritis to Crohn’s illness, digital vagus nerve stimulation is providing hope and displaying long-term outcomes. The ability of the vagus nerve lies in its capacity to impression bodily and emotional situations which have confirmed to be tough to deal with with conventional drug and medical interventions. When individuals run out of choices—for medical problems or stress administration— they discover their solution to the vagus, and understand the ability this one a part of our anatomy has over your complete system.

The hype is now consensus; the way forward for medication and self-care shall be interwoven with our understanding of the vagus nerve and the way it works. 

However First, What’s the Vagus Nerve?

The vagus is the tenth cranial nerve, originating within the mind stem and touring by means of the face, neck, lungs, coronary heart, diaphragm and stomach, together with the abdomen, spleen, intestines, colon, liver, and kidneys.2 Vagus is Latin for “wanderer,” an applicable title for the longest cranial nerve within the physique. The vagus nerve is intricately linked to temper, immune response, digestion, and coronary heart fee.3

illustration of vagus nerve through body illustration of vagus nerve through body
The Vagus Nerve and its Branches

Why is everybody speaking in regards to the vagus nerve proper now?

Possibly you understand slightly bit in regards to the vagus already, or maybe you’re studying about it for the primary time. Now that it’s in your radar, you’ll begin to discover it in every single place, from podcasts to Fb teams to mainstream information articles. Marriage and Household Therapist Justin Sunseri launched The Polyvagal Podcast, a present about all issues vagus nerve, in February of 2019 and rapidly constructed an viewers of hundreds every month alongside his co-host Mercedes Corona. “I felt a compulsion to do it,” says Sunseri. “I actually awoke one evening at 4 within the morning and the phrases Polyvagal Podcast had been pounding in my head. I knew the data can be actually good, however I had no concept what the larger image can be.”

Lisa Elliott is an aerial acrobat in Seattle who found the vagus nerve after a near-death expertise from an aortic dissection. She began the Vagus Nerve Research Group in her front room with six pals in 2015, and it’s morphed right into a thriving Fb neighborhood with virtually 9 thousand members learning the vagus collectively. “After I first began learning it, I used to be within the vagus nerve as a discrete anatomical construction,” says Elliott. “What is that this factor that may make a giant distinction in persistent diseases? However through the years, I got here to see it as an anatomical map that may lead us to a brand new mind-set about our our bodies and beings, our feelings, and our interplay with the atmosphere.”

Illustrations of Vagus Nerve contributors: Dr. Kevin Tracey, Deb Dana, Stanley Rosenberg, Dr. Stephen PorgesIllustrations of Vagus Nerve contributors: Dr. Kevin Tracey, Deb Dana, Stanley Rosenberg, Dr. Stephen Porges

Digital Vagus Nerve Stimulation (VNS)

On the medical entrance, Dr. Kevin Tracey is a neurosurgeon who has accomplished groundbreaking work within the discipline of bioelectrics, the place a small digital machine is implanted below the pores and skin of a affected person’s chest to ship electrical impulses to the vagus. He revealed a research in 20024 about mice with strokes, revealing that vagus nerve stimulation turned off the physique’s manufacturing of tumor necrosis issue (TNF), a molecule produced by the immune system throughout an inflammatory response that, when regulated, is sweet for the physique, however in extra can harm organs, trigger blood stress to drop, and result in septic shock.5 This prompted a medical trial utilizing VNS on rheumatoid arthritis sufferers6 with excessive ranges of TNF that prompted debilitating ache. On the finish of the forty-two day research, the TNF ranges of research contributors had been almost the identical as non-arthritic sufferers. Their ache was virtually gone, joint swelling was decreased, and mobility had returned. Dr. Tracey has additionally had success with Crohn’s illness sufferers, and sees a future when ailments like Alzheimer’s, most cancers, diabetes, and hypertension may be handled with bioelectronics. VNS has been authorised by the FDA to deal with epilepsy since 1997, and despair since 2005, however all the pieces else proper now could be within the medical trial levels. Along with Dr. Tracey’s work, there are research being accomplished on the impression of VNS on diabetes, stroke restoration, glucose metabolism, and lots of others all over the world.

Whereas researchers and the medical institution wade by means of prolonged medical trials and FDA approval processes, the excellent news is that it doesn’t require a surgical implant to impression your vagus nerve. 

Guide Stimulation of the Vagus Nerve

Bodily therapist and practical handbook therapist Gregg Johnson makes use of his arms to do handbook work on the vagus, and trains different practitioners to do the identical at his Institute of Bodily Artwork in Colorado. He’s been a bodily therapist for 50 years, however stumbled into an curiosity within the vagus nerve 5 years in the past when he had a scholar who had hypertension and an elevated coronary heart fee, and was on the lookout for a solution to keep away from happening long-term remedy. Johnson palpated (examined along with his arms) the neck, and will really feel that the vagus nerve was in pressure. “This was the primary time I had selectively, consciously palpated the vagus nerve,” says Johnson. “All the sudden, as all the pieces began enhancing in mobility, his coronary heart fee normalized and he began feeling like he hadn’t for months. And that evening when he examined his blood stress it had returned to regular.” Since then, Johnson has used handbook vagus nerve stimulation to assist sufferers with irritable bowel syndrome, kidney issues, and fertility points, simply to call just a few.

JARGON ALERT

Palpate: to look at part of the physique by contact for medical functions

 

This myofascial self therapeutic massage exhibits each handbook hand and soft-tool palpation.

There are a variety of issues you are able to do with breath and motion by yourself at residence to manually stimulate the vagus nerve. However to know how, first it helps to know slightly bit extra in regards to the anatomy and performance of the vagus nerve itself.

Zones of the Vagus Nerve: Supraclavicular, Supradiaphragmatic, Subdiaphragmatic Zones of the Vagus Nerve: Supraclavicular, Supradiaphragmatic, Subdiaphragmatic

Vagus Nerve Operate

The vagus nerve is a part of the autonomic nervous system, the physique’s unconscious management system that helps regulate our inside organs to optimize well being, progress, and restoration, an idea often known as homeostasis.7 The autonomic nervous system is split into two branches— the sympathetic department, which mobilizes you for motion (the “on” swap); and the parasympathetic department, also known as the rest-and-digest state (the “off” swap). The vagus nerve resides within the parasympathetic department of the autonomic nervous system. A lot of our understanding of how the vagus features inside the parasympathetic department, and our capacity to impression it by means of breath and motion, may be traced to Dr. Stephen Porges and the introduction of his Polyvagal Concept in 1994. 

JARGON ALERT

Autonomic Nervous System: the a part of the nervous system that unconsciously controls bodily perform, together with issues like coronary heart fee, respiration, and digestion. There are two branches of the Autonomic Nervous System:

  1. Sympathetic: your physique’s ON swap, supporting mobilization for motion
  2. Parasympathetic: your physique’s OFF swap, supporting rest

 

The Dorsal Advanced and Shutdown

Dr. Porges recognized two pathways of the vagus nerve. The primary pathway, the dorsal advanced, is left over from our pre-mammalian, historic vertebrate ancestors. It’s usually known as the sub-diaphragmatic department of the vagus, as a result of it originates within the mind stem and provides nerves to the visceral organs under the diaphragm, together with the abdomen, liver, spleen, kidneys, gallbladder, urinary bladder, small gut, pancreas, and ascending and transverse components of the colon.8 It’s unmyelinated, which implies it lacks a myelin (fatty) sheath, and consequently transmits data slower than a nerve that’s myelinated. When people or different mammals sense they’re in grave hazard, a surge in dorsal exercise can lead to system shutdown, together with a drop in blood stress, with a possible for fainting or state of shock.9 The dorsal vagal response is referred to in shorthand as shutdown

The Ventral Advanced and Security

The second pathway of the vagus nerve is the ventral advanced. It shaped as we developed from historic reptiles to mammals, and originates within the mind stem within the nucleus ambiguus, a gaggle of motor neurons linked to the muscle mass integral to speech and swallowing, such because the taste bud, pharynx, and larynx.10 The ventral vagus is the first regulator of the center fee, and muscle mass within the face and head. This newer ventral vagal path is myelinated and transmits data a lot sooner than the dorsal vagal path. It’s what’s generally known as our protected and social state, and developed to supply a social engagement system, which was vital to ensure that mammals to coexist, work in neighborhood, and reproduce. Folks in a ventral vagal state are typically engaged on the planet, and open to connecting and cooperating with others. 

Between the event of the dorsal vagal path and ventral vagal path, the sympathetic department of the nervous system shaped, permitting for mobilization in occasions of stress. That is most also known as the fight-or-flight response. 

JARGON ALERT

Dorsal Vagus: The oldest a part of the vagal advanced, left over from our pre-mammalian historic vertebrate ancestors. A dominant dorsal vagus leads to a shutdown state.
Ventral Vagus: The most recent a part of the vagal advanced, developed throughout our evolution from reptiles to mammals. A dominant ventral vagus presents as a sense of security and social engagement. 
Sympathetic: This a part of the nervous system developed between the Dorsal and Ventral vagal complexes; helps mobilization by rising blood stream all through the physique.

 

Polyvagal Concept

Polyvagal Concept identifies how these three neural (of or regarding nerves or the nervous system) circuits— the dorsal vagal, sympathetic, and ventral vagal— are concerned in evaluating the environment and reacting to cues of security or risk. There are three organizing rules of the polyvagal principle11:

  1. Hierarchy

    The autonomic nervous system responds to cues within the atmosphere in a specified and predictable manner. Both so as from the oldest to latest neural circuits (dorsal, sympathetic, ventral), or the most recent to oldest (ventral, sympathetic, dorsal). 

  2. Neuroception

    It is a idea coined by Dr. Porges, and describes how our autonomic nervous system subconsciously evaluates and responds to cues of security or hazard in the environment. “Detection with out consciousness,” Dr. Porges says. The vagus has greater than 100,000 nerve fibers, and communicates bidirectionally between the mind and the physique, with 80% of the fibers speaking from the physique to the mind, and the opposite 20% speaking from the mind to the physique.12  So, that “intestine feeling” you’ve felt earlier than— that’s neuroception. It’s your physique having what quantities to a “sixth sense” second, and speaking that data to your mind. 

    Vagus Nerve Information Superhighway: Gut to Brain ConnectionVagus Nerve Information Superhighway: Gut to Brain Connection

  3. Co-regulation

    That is the mutual regulation of physiological state between people.13 One instance Dr. Porges makes use of for co-regulation is the connection between a mom and her child. If a mom is calming her youngster and the kid responds by stress-free and vocalizing sounds of contentment, this has a reciprocal impact of calming the mom. If the toddler continues to be upset and doesn’t reply to the mom’s try to settle her, the mom may also get upset. Dr. Porges calls this our “organic want to attach.”

The Polyvagal Ladder

Deb Dana, writer of the ebook The Polyvagal Concept in Remedy, created the idea of the polyvagal ladder as a visible metaphor for the way we expertise physiological change as we transfer by means of the three neural circuits of the autonomic nervous system. 

Polyvagal Ladder illustration via Deb Dana. Ventral: Safe and Social, Feeling secure and connected to people around you. Sympathetic: Mobilized for flight or fight, Feeling stressed and agitated. Dorsal: Shutdown, Feeling disconnected or numb Polyvagal Ladder illustration via Deb Dana. Ventral: Safe and Social, Feeling secure and connected to people around you. Sympathetic: Mobilized for flight or fight, Feeling stressed and agitated. Dorsal: Shutdown, Feeling disconnected or numb

Ventral Vagus 

On the high of the ladder is the ventral vagus, the place the sentiments are more likely to be security, consolation, and engagement on the planet round you. You’re typically feeling content material, typically missing in acute fear about something. 

Sympathetic

 Just under the ventral vagus on the ladder is the sympathetic state, the place you progress to for mobilization in the event you detect threat. This could possibly be one thing comparatively small, like receiving a obscure electronic mail request for a gathering out of your boss that causes you to surprise in the event you’ve accomplished one thing fallacious, or one thing as horrifying as listening to a window break in your home in the course of the evening and worrying that you’re about to change into a sufferer of a house invasion. In each circumstances, your coronary heart might begin beating sooner, your palms may sweat, and your thoughts might race as you are worried about what might occur subsequent. 

Dorsal Vagus

On the backside of the ladder is the dorsal vagus, the place shutdown happens. Within the instance of the e-mail out of your boss, if it seems you had been known as into the workplace and fired, you’d seemingly transfer down the ladder from sympathetic to dorsal state, and shutdown may appear like excessive disappointment or a bout of despair. Within the damaged window instance, if it turned clear rapidly that you’re about to be a sufferer of a house invasion, shutdown might contain fainting or going into shock as a manner on your physique to guard you from a doubtlessly catastrophic bodily confrontation. 

In each situations, it’s attainable to maneuver up the polyvagal ladder as an alternative of down, relying on the circumstance. Within the instance of the e-mail, in the event you went to the assembly together with your boss in a sympathetic state, coronary heart racing and palms sweating, and it seems it was a minor request a couple of mission, you could possibly rapidly transfer again up the ladder into the protected and social ventral state, relieved that your fears about being fired had been misplaced. And the identical is true within the damaged window instance. If you happen to uncover it wasn’t a damaged window in any case, however as an alternative a tv that was left on with the amount up very loud, you’d seemingly bounce rapidly up the ladder to ventral vagus, relieved that you just and your loved ones aren’t in peril in any case. 

Hybrid States of the Polyvagal Ladder

There are situations the place two of the three neural states are mixed. Stanley Rosenberg, writer of Accessing the Therapeutic Energy of the Vagus Nerve, calls these “hybrid states.”14 The fourth state combines the ventral vagal (protected and social) and sympathetic (mobilization) to create mobilization with out worry. Examples of this could be going to a zumba class, enjoying tag together with your youngsters, or partaking in a pleasant competitors on the basketball courtroom with pals. The fifth state combines the ventral vagal (protected and social) with dorsal vagal (shutdown) to create immobilization with out worry. This creates a sense of calm and security, and examples might embody mendacity nonetheless with a trusted companion after intimacy, or cuddling together with your sleepy youngster earlier than bedtime. 

If you happen to’re caught in a dorsal state and really feel such as you don’t have any get-up-and-go, breath may also help.

How To Transfer Between States With Breath

Until you’re in a hybrid state just like the examples talked about above, which incorporates the protected and social emotions of the ventral vagus advanced, being caught in a sympathetic (fight-or-flight) or dorsal (shutdown) state may be draining to keep up— mentally, emotionally, and bodily. If you happen to’re locked in a sympathetic state, you may really feel such as you’re continuously careworn, at all times ready for an additional metaphorical shoe to drop. If you happen to’re locked in a dorsal state, it’s possible you’ll end up in a perpetual malaise, unable to meaningfully have interaction with the individuals in your life the world round you. 

Fortunately, there’s a available solution to transfer your self up the polyvagal ladder to incorporate the protected and social emotions of the ventral state, and it begins together with your breath. “The best vagal stimulation you can recruit is having the ability to exhale slowly,” says Dr. Stephen Porges. Stimulating the vagus nerve with sluggish exhales slows down the center fee and provides your physique cues of security. “Within the mind stem there’s truly form of like a swap,” continues Porges. “It’s like a sizzling water/chilly water possibility on the identical knob. Whenever you exhale, the vagal influences to your coronary heart’s pacemaker get optimized. Whenever you inhale, your coronary heart fee goes up. And while you exhale, your coronary heart fee goes down. If you happen to spend extra of your time exhaling, you calm your physique down. If you happen to shift rations in order that more often than not you’re inhaling, you’re hyperventilating. You’re huffing and puffing. Whenever you see anxious individuals, they’re inhaling on nearly each sentence or each phrase. They’re huffing and puffing.”

Tune Up Health founder Jill Miller designed a complete immersion program, Breath & Bliss, across the polyvagal principle, utilizing breath work, place, motion, neighborhood, and a delicate, air-filled sponge ball to manually stimulate the vagus nerve, and provides college students instruments to maneuver out of a fight-or-flight or shutdown state. “I need individuals to really feel like they’ve as many choices as attainable to have the ability to modulate their very own state,” says Miller. “And to know the ‘why’ actually helps with the expertise of it. My bias is that I consider as soon as you understand you can shift your physiology and also you prepare your self to witness your physiological shifts, it turns into a richer expertise and also you don’t really feel so victimized by your moods or response to issues. I need empowered restoration to be in everybody’s toolkit.”

Breath & Bliss is  a motion and breath-based strategy that leans into Porges’s principle of how we reply to the environment, and makes use of that information for steerage on getting ourselves to a state the place we are able to really feel protected with ourselves and within the firm of others. “One attribute of being a human being is that our physique reacts to risk,” says Porges. “But it surely doesn’t simply react to risk, it transforms how we work together with different individuals. So we now have to know that our physique is shifting states to attempt to take excellent care of us, however in doing that, it distorts how we see the world. We all know that our our bodies change states and promote sure attributes to guard us. The problem is, can we create the construction and context for our our bodies to really feel welcoming sufficient to deliver different individuals into our world? Can we surrender our persistent should be defensive, to take an opportunity to be accessible and stay with our personal vulnerability?” 

Senior Tune Up Health® Teacher Lisa Hebert leads the Breath & Bliss Immersion internationally and has seen it rework college students as they discover ways to transfer between states. “I believe the fantastic thing about the polyvagal principle is that it brings us again to fundamentals,” says Hebert. “Social interplay, human contact, human connection, a caring voice. All of this stuff we all know so innately when we now have a child in our arms, however we develop up and push all that away so we are able to get robust and do all the pieces ourselves. So we might lose it briefly, nevertheless it’s this innate information that we now have in our intestine someplace.” 

Hebert has additionally accomplished Breath & Bliss work with first responders and former navy members with PTSD. Jason Burd was a firefighter in Canada who virtually died when a roof collapsed in throughout a rescue operation in 2006. After the accident he went again to work, however suffered a again damage in 2010, adopted by a lung damage in 2011. He ended his profession as a firefighter due to bodily ache, PTSD, and suicidal ideas. He did Breath & Bliss with Hebert, the place he discovered respiration workouts and rolling strategies to stimulate the vagus nerve with the Coregeous ball. “There have been so many lightbulb moments,” says Hurd. “I noticed that my restoration is in my arms. After I got here residence after the primary day of the course I instructed my spouse that I felt like the within of my neck was greater. My capacity to breathe felt utterly totally different. Now I take advantage of the Coregeous ball a minimal of as soon as a day, normally twice.”

Hurd’s expertise is an instance of how tuning in to breath, and manually stimulating your individual vagus nerve, can lead to a robust shift from persistent ache and fight-or-flight anxiousness, to empowered restoration.

“That’s what I name embodiment,” says Miller. “It’s when somebody feels their manner by means of their physique, partaking in a acutely aware dialogue of their senses, emotions, urges, and desires. Be prepared to reply and mother or father your self with curiosity and assist.”

In accordance with Dr. Porges, understanding polyvagal principle may also help us negotiate with our our bodies to optimize our experiences. “Amazingly, while you change into extra conscious of what your physique’s making an attempt to do, the physique tries to work with you. We’ve handled our physique as if it was one thing that we needed to comprise or management. However the message is that we stay in our physique. Deal with your physique with honor and respect, and your physique will serve you effectively.” 

Jill Miller Vagus Nerve Quote: "This is a way to be in conscious dialogue with your senses; the feelings, the urges, and the needs of your body. Be willing to respond and parent yourself with curiosity and support." Jill Miller Vagus Nerve Quote: "This is a way to be in conscious dialogue with your senses; the feelings, the urges, and the needs of your body. Be willing to respond and parent yourself with curiosity and support."
Of all the excellent news science is telling us in regards to the vagus, maybe an important is that we now have the flexibility to befriend this wandering nerve proper this very minute. Whereas researchers everywhere in the world proceed to discover methods trendy medication can use the vagus nerve to heal persistent illness, you can begin respiration now. You can begin listening to the cues your physique is supplying you with now. You’ll be able to start taking your restoration into your individual arms now.  For extra on the vagus and constructing resilience, see Jill Miller’s new ebook
Physique by Breath.

At-A-Look: Methods to Stimulate Your Vagus Nerve to Flip ON Your OFF Swap

To assist your physique “activate” the vagus to enhance its perform, there are a number of social, physiological and bodily “methods” that your physique can make use of.

 

    • The simplest solution to stimulate the vagus nerve is thru sluggish, deep, diaphragmatic respiration that emphasizes elongation of exhales.

 

 

    • Singing, buzzing, or enjoying a wind instrument additionally excite this downregulation nerve. (As demonstrated under.)

 

 

  • Massaging areas of the physique that are innervated by the vagus alters vagal tone and supplies a rest response. These embody tolerable stress to:
    • Muscle mass of face, facet and entrance of neck and head
    • Ribcage
    • Stomach

     

     

  • Positioning the physique in ways in which compress and decompress areas the place the vagus nerve innervates:
    • Rocking, which gently oscillates the pinnacle
    • Neck stretches
    • Stomach and torso rotations that compress and decompress the viscera
    • Gently flexing and increasing the backbone to have an effect on stress and/or stretch within the visceral space

     

  • Chewing meals, sucking on meals/objects and gargling
  • Safely rubbing the within of your ear (the bowl formed bits, not your ear canal)
  • Optimistic social interactions
  • “Feeling protected within the arms of one other” or “Feeling protected within the arms of one other applicable mammal, like a canine,” Dr. Stephen Porges
  • Meditation and Yoga

 

Learn to Flip ON Your OFF Swap!

Obtain our useful information The 5 P’s of the Parasympathetic Nervous System.
The 5 P's of Activating Your Parasympathetic Response: Perspective, Place, Position, Pace and Palpation The 5 P's of Activating Your Parasympathetic Response: Perspective, Place, Position, Pace and Palpation

Endnotes

  1. Stanley Rosenberg, Accessing the Therapeutic Energy of the Vagus Nerve, (California: North Atlantic Books, 2017), 37.
  2. Vince, Gaia. “Hacking the Nervous System to Heal the Physique.” Uncover Journal, Might 2015
  3. Breit, Sigrid, et al. ‘Vagus Nerve as Modulator of the Mind-Intestine Axis in Psychiatric and Inflammatory Problems’, Frontiers in Psychiatry, 13 March 2018.
  4. Tracey, Kevin J., “The Inflammatory Reflex,” Nature, 19 December 2002.
  5. “How Electrical energy Might Exchange Your Drugs.” YouTube, uploaded by TEDMED, 26 Might 2016.
  6. Koopman, Frieda A., et al. ‘Vagus Nerve Stimulates Cytokine Manufacturing and Attenuates Illness Severity in Rheumatoid Arthritis’, Proceedings of the Nationwide Academy of Sciences of america of America, 19 July 2016.
  7. Porges, Stephen, “The Pocket Information to the Polyvagal Concept,” (New York: W. W. Norton & Firm, Inc., 2017), 15.
  8. Stanley Rosenberg, Accessing the Therapeutic Energy of the Vagus Nerve, (California: North Atlantic Books, 2017), 19.
  9. Stanley Rosenberg, Accessing the Therapeutic Energy of the Vagus Nerve, (California: North Atlantic Books, 2017), 32.
  10. IMAIOS e-Anatomy on-line, 
  11. Dana, Deb, “The Polyvagal Concept in Remedy,” (New York: W.W. Norton & Firm, Inc., 2018), 4.
  12. Scudallari, Megan, “Scientists Uncover How Vagus Nerve Stimulation Treats Rheumatoid Arthritis,” IEEE Spectrum, 18 July 2016.
  13. Porges, Stephen, “The Pocket Information to the Polyvagal Concept,” (New York: W. W. Norton & Firm, Inc., 2017), 9.
  14. Stanley Rosenberg, Accessing the Therapeutic Energy of the Vagus Nerve, (California: North Atlantic Books, 2017), 33.

Searching for extra data on self-care?  Study extra about Tune Up Health right here:

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