Protocol Hub · Devices
Protocol v4.1 · 2026-09-18 · built against master regimen rev 7.75
Nathan Distelhorst · supersedes v4.0 (August 2026), v3.0 (April 2026) and v2.0 (March 2026)
Chase the sensation, not the number — strong but comfortable, tingle or lip pull.
Spray 2–3 pumps · vertical, pulse point, below the jaw · both electrodes flat.
Missed a pre-meal slot? Run it as you sit down.
8:00 PM BP is the evening sentinel. Take it before the 9:00 session.
4 min · intensity 6 · either side · no breathing pairing required
Your own saved favourite, moved up to the clinical duration. It shares the 6:15 AM fasted slot, between the 6:00 AM fasted stack and the 6:30 AM Rx cluster, so it lands ahead of the day's first stimulant dose rather than chasing it. It is also the safest window you have — your morning diastolic has never broken 60 in the 28-day record.
4 min · intensity 6–7 · alternate sides daily
Rides the pre-Meal 1 anchor you already run, so it adds no new alarm and no new decision — it just gets longer. Meal 1 is the fast-break and the heaviest load of the day. Honest note: the −15 min placement is convenience and habit, not evidence. The pre-meal rationale in v2.0 and v3.0 rested on rat data. Keeping it because it works for you is a good reason; keeping it because it "primes Creon" is not. Missed the −15? Run it as you sit down — for the meal-linked part, right before the first bite is at least as well aligned ⟨C·9-07⟩.
2 min · intensity 6–7 · alternate sides
Your 8/20 practice, kept. Rides the 2:45 PM pre-meal slot (taurine · theanine); DAO itself moved to 2:55 on 8/29. Skip it before you skip a core session — it is the one with the least behind it.
2 min · intensity 6–7 · alternate sides
Your 8/20 practice, kept, and moved with dinner. Dinner went 6:30 → 6:00 at rev 7.65 (9/9), which put the old 6:15 slot inside the meal. 5:45 is the same −15 as the other two, and it rides the pre-dinner taurine · theanine · berberine slot — the pair it rode at 6:15 moved there with dinner ⟨C·9-18⟩. This one sits closest to the evening pressure trough, so if any single session gets cut on a low-BP day, cut this one.
4 min · Moderate (your saved setting) · either side
The one you asked for, and it holds up. Placed after the 8:00 PM blood-pressure reading so that reading stays a clean pre-session baseline, roughly an hour past the last eating occasion, and 30 minutes ahead of melatonin. Morning-plus-night is also the only cadence Truvaga's own consumer studies ever tested.
No on-Truvaga blood pressure has been compared yet. Your 28-day record ends 8/10 and you restarted ~8/13, so every reading since is on the device, and none has been set against the pre-device 126/66. Every sub-60 diastolic in that record is an evening reading, floor 57 against a stop rule of 55. Nothing needs changing, and the 57 predates the device. But the 8:00 PM reading you already take is now the sentinel — it is free, it is already in your schedule, and it is the only thing that would catch a drift.
Session → Favorites → save each of these. Then the whole protocol is three taps a day instead of five screens.
The two Extra sessions run at 2 min and can reuse the Midday Anchor favourite — just switch the length toggle at the Timer screen.
The manual's actual target is strong but comfortable — a tingle, or a slight downward pull at the lip. Most users land between 4 and 7. Your Timer default is Moderate: 7, which is the top of that band.
v3.0 targeted 6–8 on every pre-meal session, with "higher intensity = stronger cholinergic activation" as the reason. That dose-response claim has no source and sits above the manufacturer's own band. Chase the sensation and record the number — the number is a readout, not a setpoint.
Unfinished: I have confirmed two band labels from your screenshots — Gentle and Moderate: 7. Drag the slider to 1 and to 10 and tell me what the ends are called, and I will put the full vocabulary in the next version. Until then the numbers above are the spec and the bands are secondary.
v2.0 and v3.0 defaulted to the left side for digestive benefit, citing implanted VNS. That convention exists because a surgically implanted electrode avoids the right vagus's innervation of the SA node — a design constraint for a permanent implant running continuous stimulation, not for a four-minute session through skin. electroCore's own trial protocols stimulate both sides routinely, and the current manual says simply: choose either side. Alternate day to day. It removes a decision and spares the skin.
5 seconds in, 5 seconds out, nasal, 6 breaths a minute, 5–10 minutes. Pair it with the 6:15 AM and 9:00 PM sessions as before. But not as an amplifier. Paced breathing at ~0.1 Hz has its own evidence for baroreflex and HRV that is at least as good as the device's, and it is free. It stands on its own feet; the "dual-pathway vagal activation" framing was decoration.
Written 8/20 for v4.0, against rev 7.49. Regimen facts in this tab are as of that date — the regimen file is the source for current ones.
Every clinical protocol built on this hardware delivers two consecutive stimulations per occasion, two or three occasions a day — the migraine prophylaxis trials, the gammaCore gastroparesis study. You have been running one. The 4-minute toggle closes that gap at no cost.
Flagged honestly: that 4 min = two 120-second stimulations is inferred from the duration. electroCore does not document it that way. It is the best available reading, not an established one.
The 2025 systematic review of non-invasive VNS in gastrointestinal disorders — 7 randomised trials, 644 patients across functional dyspepsia, IBD, IBS and functional abdominal pain — found consistent symptom improvement over sham. The mechanism the authors credit is anti-inflammatory and anti-nociceptive.
"Cervical VNS promotes pyloric relaxation and accelerates gastric emptying" is a rat MRI study, presented in v2.0 as human physiology. The human work is one open-label proof-of-concept scoring symptom diaries with no emptying measurement, plus a small uncontrolled trial where idiopathic gastroparesis improved but functional dyspepsia got worse. There is no human study of nVNS on pancreatic exocrine secretion at all.
Consequence: the device earns its place on inflammation and symptom load, not on coordinating with Creon. That is still a good reason. It is a different reason, and it stops privileging the −15 min slot.
rev 7.49 gated this device with one untagged line: lowers HR and BP · morning fasted, never postprandial. That is a mechanism story generalised from implanted VNS. For cervical non-invasive stimulation specifically:
Both directions, because that is the rule: the effect is not nil. Sham-controlled work at Emory shows tcVNS genuinely reduces sympathetic reactivity and vasoconstriction, and transcutaneous VNS measurably lowers muscle sympathetic nerve activity. But those effects are small, transient, and concentrated in stress reactivity rather than resting tone, and they are largest in populations with high autonomic arousal.
Postprandial hypotension is not excess parasympathetic tone. Microneurography shows healthy people increase sympathetic outflow after a glucose load and affected people fail to; the splanchnic-pooling story is not supported. So the mechanism that would matter is that tcVNS blunts the very compensatory arm whose failure defines the condition — a better-founded concern than the one on file.
It still does not justify the gate as written. You have run pre-meal sessions for a week without incident, the measured effects are transient, and your 57 floor predates the device. The gate is struck; the 8:00 PM reading replaces it.
The device is yours ⟨N⟩. The schedule was never yours ⟨C⟩. Seven sessions, then six, the mode-to-slot map, the intensity targets — all designed in March 2026 and carried forward. The burden-of-proof rule covers an established member returning to the regimen. It does not make six sessions established, because the six were never yours to begin with. That is the boundary clause in your own rule, and this is a clean instance of it.
Truvaga restarted ~8/13. Gabapentin started 8/15. Oral iron started 8/17. Three introductions in five days, and all three are read on overlapping subjective signals — sleep quality, calm, energy, restless legs.
Nothing needs undoing and no alarm is intended. The point is only that anything you notice over the next few weeks is unattributable by construction, and a later revision of any file should not record it as though it were attributable. Iron in particular has a long ramp and is the one with a documented target.
Deliberately not on this list: HRV as a primary endpoint. It moves for a dozen reasons a day, new variables have kept landing since 8/20, and a fortnight of it will tell you nothing you can act on. Revisit when the window is clean.
To support@truvaga.com · 1-800-643-2036. This is the question the entire "hybrid mode" idea depended on, and nobody has ever asked it.
Subject: Does Session Goal change the stimulation output? Hello, I use a Truvaga Plus daily and I schedule my sessions carefully. I have a question the manual and the app do not answer. The app offers six Session Goals (Reduce Stress, Better Sleep, Improve Mental Performance, Improve Physical Performance, Increase Happiness, Other). I would like to know, specifically: 1. Does selecting a different Session Goal change the actual electrical output of the device -- frequency, waveform, pulse pattern, burst structure, or anything else? Or is the Goal a label used for session history and Feeling Score tracking, with identical stimulation delivered either way? 2. If the output does differ by Goal, can you tell me how, or point me to documentation? The Truvaga Plus User Manual (rev 4, 07/2026) does not mention Session Goals at all. 3. Is a 4-minute session delivered as one continuous stimulation, or as two consecutive 2-minute stimulations? Thank you -- I am trying to set my sessions on the basis of what the device actually does rather than what I have assumed.
Answers 1 and 2 decide whether goal-to-slot assignment is physiology or bookkeeping. Answer 3 decides whether the 4-minute setting matches the clinical dosing convention or merely resembles it. Send me the reply and I will fold it into the next version.
Not on a date — on a trigger. Review when the attribution window clears, which means: no new introduction for 14 days, and iron far enough along that its own effects are separable. At that point a single-variable read on Truvaga becomes possible for the first time since April.
A 9/7 re-derivation proposed a different day: the main midday session at 2:00 PM, the noon one optional at 11:55, no pre-dinner session, and no 15-minute lead. On 9/8 it went on hold. The early-afternoon stimulant peak could make the noon session the load-bearing one, and one day's impression cannot settle that ⟨C·9-08⟩.