Dr. Ellen Vora is on the show this week to share several holistic approaches to the treatment of anxiety. Ellen is a holistic psychiatrist, acupuncturist, and yoga teacher. She takes a functional medicine approach to mental health—considering the whole person and addressing imbalance at the root.
In this episode, we talk about whether or not we are experiencing an anxiety epidemic, strategies for addressing anxiety, the difference between “false” and “true” anxiety, and so much more. I am beyond excited to introduce you to her. She is so smart, has a wealth of information, and I had so many questions for her. I hope you enjoy this conversation as much as I did!
Some other topics we explore:
- The cause of the anxiety epidemic (10:15)
- Ellen talks about her approach to defining anxiety, “false anxiety” and some strategies for addressing it (13:43)
- The connection between hormones, birth control, and mood regulation (18:06)
- The role of psychedelics in treating anxiety and the mystical experience hypothesis (23:14)
- Ellen shares her controversial views on sunshine, why our bodies benefit from the sun, and some healthy ways to get sun exposure (31:00)
- How we can realistically improve our sleep and why is scrolling on our phones at night relevant to anxiety (42:42)
- Ellen’s hot-take on the effects of nutrient dense diets on post-partum depression and anxiety (51:50)
You know how I love a good personal development book, right? I’ve compiled a list of book recommendations, as mentioned in past episodes. Check out these amazing book recommendations here. Happy reading!
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ELLEN VORA, MD, is a holistic psychiatrist, acupuncturist, and yoga teacher. She takes a functional medicine approach to mental health—considering the whole person and addressing imbalance at the root. Dr. Vora received her B.A. from Yale University and her M.D. from Columbia University, and she is board-certified in psychiatry and integrative holistic medicine. She lives in New York City with her husband and daughter.
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It's your birthright to feel well, but this modern environment with our traumas, with our inflammatory foods, with our nutritionally bankrupt foods with our blue light after sunset, this environment sets us up to be anxious. And so we always have options to take to support that. But you don't need to feel overwhelmed by it. Think of it as a buffet reach for what resonates so it feels accessible. That's where you start. Maybe you make a little bit of incremental progress and the next change starts to feel within reach.
You're listening to Make Some Noise Podcast episode number 478 with guest Dr. Ellen Vora.
Welcome to Make Some Noise Podcast your guide for strategies, tools and insight to empower yourself. I'm your host, Andrea oh and global speaker, entrepreneur, life coach since 2007, and author of three books that have been translated into 18 languages and are available in 22 countries. Each week, I'll bring you a guest or a lesson that will help you maximize unshakable confidence, master resilience and make some noise in your life. You ready? Let's go.
Hey, everyone, welcome to another episode of the podcast. I'm so glad that you're here. You know what I'm drinking right now that I'm kind of wishing I never bought this. By the way, this is not a sponsored ad. This is just me telling you how delicious something is and it was sitting in front of me and I have ADHD, so that's apparently how my mind works. What do you like about this thing? Dunkin’ Donuts iced coffee. I don't think I've ever had one. Not an iced coffee. I've had their coffee, regular coffee. And I bought it at the grocery store and brought it home with me and I… Why didn't anybody tell me this was so good? I am probably going to have it all the time now and I have told you about my caffeine processing. I'm one of those people that cannot drink. It's like Cinderella turning into a pumpkin at midnight. I turn into an insomniac after like noon if I'm drinking it. It's so good. It's so good. And it's 11:47am as I record this and there's like half a glass still there. So wish me luck. Wish me luck into the abyss. If they want to sponsor my podcast they can.
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What else is going on? I feel like I feel like, quick life update because I also think that many of you can probably relate to what I'm going through. I told you all about my Hashimotos diagnosis and how 2020 and 2021 were rough, in terms of my mental health too, which I think probably the undiagnosed Hashimotos wasn't helping my mental health. But my physical health I felt like shit. Like what is going on, I finally got the diagnosis and got put on thyroid medication and it helped. It helped so much, I didn't need a… Vitamin D supplement. I want to say that too. That helped a lot. My vitamin D was really low. And then I was able to like get out of bed and like not feel like I needed to take a nap by 9am. It was it was really bad. And I had a really huge lack of motivation. I just didn't want to do anything at all. So we finally get to the bottom of it. But the one thing that hasn't gotten better, it's gotten better a little bit, but not really are the body aches. Especially my lower extremities, the doctors like to say, my ankles, my knees, my hips, and like just all over ache. It's not in my upper body, it's just in my lower body, my lower back a little bit too. And it doesn't really matter if I stretch, it doesn't matter if I drink more water, it doesn't matter if I drink electrolytes, I just cannot shake it. It feels like when I was training for a half marathon, or like a travel on that I've done in the past, like when I'm training really hard. But I'm not at all like I'm going on 30 or 40 minute walks with my dog, and like doing some weightlifting, but nothing that should cause this.
Anyway, I've been on my TikTok feed, of course seeing a lot of stuff about hormones and how you know, it's extremely overwhelming. Is anyone else so overwhelmed when you start looking into it and like what tests should I get, even if my hormone tests are normal, there still could be a problem so I have to find this kind of doctor. And what is the difference between… Oh, my God, what? I am lost in space. I am lost in space. The reason I'm telling you this is because coming up on the podcast, I don't know if it's after this theme, I am going to do a women's health theme and we're going to be talking to some people. Because I know that there are some of you that are listening in your 30’, maybe some of you in your 20s and buckle up. Buckle up. No one told me about this, and I'm generally speaking, this does not happen to everybody. But I have yet to talk to somebody who's my age who isn't like either in some kind of similar boat, or like a woman in her 50s or 60s who has been there and either just trudged through it or gotten some kind of help and it's taken a long way and tried so many different things that didn't help until they finally found the thing that did. And there's not a one size fits all. And again, I think I mentioned this, like your hormones can come back normal, btut there's still a problem. So I don't know how they figured out figured that out. I don't know if it's like a magic eight ball type of thing, type of situation. But I also was looking through all of my records and my testosterone has never been checked. It's never been checked ever. So that might be a problem. Yeah, so we'll see. Stay tuned. I know you're gonna be waiting with bated breath. But that's what I've been digging into. And I started digging into it and I get overwhelmed. I shut the whole thing down which is common for me is the way I like to approach things. This is a long intro.
Dr. Ellen Vora is here. I love her so much like she's one of those like if it wasn't already married, I'd ask her to marry me. I met her at Sun Valley Wellness Festival. We were speaking there. And I had like a three hour conversation on the last morning with her Britt Frank and Nora McInerny…thought her last name. I'm so I'm terrible at that. Terrible Thanks For Asking host. She's super funny and fun and lovely. And then Dr. Ellen, just so smart and I was like get your booty on my show and the dance floor if you want but I am so excited to bring her to you. I asked her so many questions. Speaking of being overwhelmed, take this episode in bite sized pieces. I had so many questions that I wanted to get through, so it was kind of a rapid fire. I tried my best not to interject my own stories in here because she has such a wealth of information and I know that so many of you struggle with anxiety. And this is her specialty. She wrote the book, The Anatomy of Anxiety. So let me let me tell you about her before we get started. Ellen Vora MD is a holistic psychiatrist, acupuncturist and yoga teacher. She takes a functional medicine approach to mental health considering the whole person and addressing imbalance at the root. Dr. Vora received her BA from Yale University and her MD from Columbia University and she is board certified in psychiatry and integrative holistic medicine. She lives in New York City with her husband and daughter. So without further ado, here is Ellen.
Ellen, thank you so much for being here.
Andrea, it's so good to be here. Thanks for having me.
We had to take a minute because we were laughing so hard before I hit record. So… Which is good because we're talking about something that none of my listeners struggle with at all, so I don't even know why aren't you on. And that's anxiety.
Yep. So yeah, crickets out there. But in case this resonates with like one or two listeners, maybe the conversation will be worth while.
This is gonna be my lowest downloaded episode. I know it. So we might as well just get it over with. Let me jump in and ask you kind of like the elephant in the room, and it's sort of like… Okay, so when I was younger, I don't even know I knew the word anxiety until I was, I don't know how old I was. And I was 27 when I died when I was diagnosed, I never forget, because they put you on like a scale, severe anxiety plus moderate panic disorder. And I remember I had such shame around it and… So it was a very different time back then, even though that was 2002ish. So what is causing the epidemic of anxiety? Or is it even fair to call it an epidemic?
Yeah, I just stuck on the fact that they called it moderate panic disorder, because if you've ever had a panic attack, nothing feels moderate about that experience.
Yeah, it was like a scale and it was… That's exactly. I guess that meant like I wasn't having them every day. Yay.
Yes. She made it a day without expressing exquisitely uncomfortable anxiety. So I do actually believe that we're in an epidemic of anxiety. And sometimes you hear the pushback, you hear a variety of different push backs on that. One is that we have lower amounts of stigma around mental health these days, and this is a good thing. And we're more comfortable talking about it. We're screening for more mental health issues. So everyone's like, is it really worse than it used to be or is it just that we're talking about it? It's both. And you also see people push back and say, well, is everyone really having clinical anxiety or are they just stressed? And to me, that distinction is immaterial. I think even we always have to ask ourselves, like, why are we even drawing that distinction? Ultimately, the purpose of our diagnoses is so we have standardized nomenclature for medical research, and to gatekeep invasive interventions. But in my book, like, I'm more interested in less invasive interventions anyway. So it's a continuum, of course. Some people have very debilitating anxiety, causing quite a bit of suffering and compromising their quality of life. For some people. It is milder, but it's all anxiety. And I think it's happening more these days than it used to.
Okay, and what is considered an invasive measure of treatment?
Okay, okay. I thought you were gonna say like shock treatment. I mean, that but also… Yeah, that yeah, my grandmother, when she… Okay so my dad was born in 1936 his mother had that, for, she had depression. Yes, it was when he was a child. So it was probably in the 1940s.
Yeah, you come from a line of witches.
Yeah, that's just our legacy, on that side.
Yeah. So I mean, iECT it's interesting… This is such a different era of my thinking differently as a psychiatrist, like right now, I'm very trying to take a holistic approach, use diet and lifestyle wherever possible. But I remember back in my days as a med student and resident, I really wanted to advocate for a different view of ECT. Because basically, it's actually not the worst treatment ever, and in certain ways, it's more effective and as a lower side effect burden than some of our meds. So you know, it's all just to say, there's always nuance about all these discussions, but I don't I don't prescribe a lot of ECT. Because I'm actually…
I would assume that I would assume that's not your that's not your thing. Well, you say you have a different approach and you just said that to defining anxiety so can you say a little bit more about that.
Yeah, I was taught to think about it the way you were diagnosed, right, like generalized anxiety disorder, and then there's panic disorder with a really out agoraphobia. Always with diagnosis, the idea is that this will steer management will tell us okay, now we have that answer. What do we do about it? And I realized that in my practice, none of those diagnoses were searing practice in a meaningful way. And when I started to observe as a much more useful classification system, was to think of anxiety as two types. One is what I would call false anxiety or avoidable anxiety, and we'll come back in a second to how offensive and invalidating that term sounds like false anxiety.
Yeah, I'm like… the suspense is killing me.
We’ll come back around to that. And then the other type is true anxiety, which is purposeful anxiety. It's not something to pathologize it's not something to suppress, we cannot gluten free or decaf coffee our way out of true anxiety. What we really want to do is slow down and listen to it and honor it. But it has to say false anxiety, I don't call it false to invalidate the very real suffering. I was in a state of false depression for years. of my life that was life altering struggle. But what I ultimately recognized was that it had a physical basis. I was going to a therapist, I was talking till I was blue in the face, none of that really did anything. It helped me with insights, but it didn't change my mood on a day to day basis. But what did was for me, my body, getting off birth control pill, and getting off gluten. And those were actually the things that made the biggest difference. And so I call that false depression. It felt like any other mental health issue, but it had a straightforward physical basis, and a straightforward solution. And I think when it comes to anxiety, there's a lot of unnecessary suffering happening right now, from all the ways that modern life trips our body into a stress response. And that can feel identical to anxiety.
So somebody with maybe false depression, I'm using like air quotes over here, there might not be anything circumstantially that would point towards it, but they still have that, that, you know, dark feeling of, you know, all of the symptoms that depression symptoms, and then like for anxiety, because sometimes I just wake up with it. Like, life is great, but I will wake up with like, not, I wouldn't say a rap like an elevated heart rate and just sort of like that feeling of just the start almost like a startle response happening, like, and no rhyme or reason. I don't feel like it has any rhyme or reason. It's, any day in my cycle that can happen is that kind of what it is?
It really can be both right, we can have false anxiety and still also have very real problems going on in our life. Really just that the false anxiety is making our real stressors that much harder to deal with. Also, especially what you're describing, when you wake up, and seemingly out of nowhere, you just woke up on the wrong side of the bed, or it's the afternoon and out of nowhere, you're suddenly irritable or anxious or sad or angry, that is very likely to be false anxiety. And this is really built on the work of a woman named Julia Ross. She has a book called The Mood Cure, and she first detail this idea we have false moods or emotional imposters and it has a lot to do with our physiology. When something in our physical body gets out of balance. And so with anxiety, really common culprits, it's something as innocent as a blood sugar crash, or you could be hungover, you could have had an extra cold brew coffee that day, maybe there's something off in your gut, you know that one is common. There's something off in your gut, maybe you're inflamed, maybe it's the day or two before you're supposed to get your period, which is its own nuanced conversation. Is that false? Is that true? There's conversation unpack there. Introduce withdrawal is really common. So if you take psychiatric medication, yes, like you said, you woke up right? If you're typically taking something like an SSRI or a benzodiazepine in the morning, then you might wake up in a panic because your body is at its pharmacologic nieder, which is very medical speak for, that's the point when your blood levels of that medication are at its lowest and so your body is like I need that pill.
It's kind of a withdrawal?
Exactly. It's inter dose withdrawal.
Side question. And I have like, like six more questions to get through, so this is an extra one. You mentioned birth control. Can you say more about that? I know that that was it's not for everybody. But that was one of your kind of variables that you took out, that you feel like was causing your anxiety.
Yeah, I mean, on the umbrella sense, women having control over our reproduction is a public health victory is a feminist victory. So let's put that there first. And then there's no free lunch in this world and it's hard to stop the train of fertility in the body and it doesn't come without consequences. So birth control, we just need better informed consent. I wasn't given any informed consent. Zero. When in fact it can, it can certainly deplete your body of certain nutrients and minerals, which can contribute to mood issues, it can change your gut flora can change inflammation levels, the health of your liver, it can be carcinogenic in certain ways. There's also just the fact that it impacts your mood, because, like, how the hell could it not? We know that the days before our period, our mood is different, and that relates to hormones. And here we are swallowing a pill every day or having a ring around the cervix or an implant or a patch, whatever it is, or shot. It's all exogenous hormones, and of course, it impacts our mood. And this is a case of immense amount of medical gaslighting that was happening for so long, where women would go on the pill come in, sometimes girls adolescents, come in and say, well, I think I'm sad or I think I'm more anxious, I think I'm crying more, and I did this and I was completely dismissed. There's no evidence for that. I'm sure you think that but it's actually not the pill, sweetie. It's something else. Are you under a lot of stress? And so it would have me thinking, am I crazy or did I start getting weepier when I went on the pill? And now we actually have the evidence that tells us that indeed, it impacts depression and anxiety levels, of course. And in fact, the younger we take it seemingly like the more chronic that impact can be. It seems to even affect brain development in a way that can contribute to more enduring mental health issues. All of this is deeply disconcerting. It's not to say we need to outlaw the pill. It can still have a role, but we just need a really bespoke understanding of for you, does it impact your mood, and it's probably not your best option. And let's look at other alternatives.
I am so suss, as my daughter would say. I went on the pill at 15 and was on it consistently until I was, I think there was a period somewhere in my 20s when I went off, and I don't even remember why, but until I got pregnant when I was 31. And then I was, you know, pregnancy and right after childbirth, I had some support some pretty severe postpartum anxiety, more so with my first child, and even a little side of psychosis there for a little while. But after that… And I've often and I talked about all the time of like, my anxiety has gotten so much better in my 30s. And it is until this moment have I put together that also in conjunction was when I went off the pill. Because I would go into these rages. And also my ex was a shithead. Like, let's be fair. I had reason, but like, my, my emotional range was unreasonable sometimes. Like it just flying off the handle. And I didn't I didn't have a whole lot of emotional regulation. And I wonder if it was birth control pills.
This is a case of a both and right? Because some people will be listening and say, well, there are confounders there, you're in your 30s not your 20s, you're out of an abusive relationship, you know? Whatever it is, and that's all true. And the pill, quite possibly, I would say even likely was impacting your emotional regulation.
It was a consistent medication I was on that whole time. Yeah.
I have a lot of patients where basically, when they first went on the pill happened to coincide with when they became a patient in the psychiatric system. So they go on the pill for acne, for period regulation, whatever it is, and then it happens to preceded by a couple of months when they're like I'm feeling more depressed. I'm going to see a psychiatrist. I'm more anxious. Now I'm getting put on an SSRI and a benzo and Adderall and Ambien and Wellbutrin snd they sort of wash up to shore in my practice 15 to 20 years later, and we start to strip away different things. And it's actually the pill that was the initial insult. And no one connects the dots, right? Like, there's a line in my book, something like our gut and our brain are talking to each other, even if our psychiatrists are good gastroenterologist or not. And you know, no psychiatrist is thinking like, well, did you just go on the pillow for your very first time, a month before you saw me? But a lot of my patients, that's the chronology. It started with that hormonal…that starting to take exogenous hormones is what got them on the path of starting to struggle with their mood.
That's so interesting. Okay. Okay. And by the way, I haven't mentioned it yet, but your book is called The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response. Can we talk about something that I'm selfishly super interested in, in that psychedelics. So can you talk about the role of psychedelics in treating anxiety?
Yeah, so the weird thing about psychedelics we're in like a hype bubble right now with them, right? So for the long is… T
They're having a moment, psychedelic.
A moment, we're almost though it's almost like the moment has passed and now we're already having the backlash. For the longest time, you know, they had a moment of sort of more first wave of psychedelic research and then there was moral panic around it. It was totally shut down for a longest time and then others…
Are you talking about like in the 1960s?
Yeah. And then then the moral panic that kind of like, you know, you're gonna lose your mind, you're gonna become a little hot, and jump off a building.
And yeah, I was a child of that. Do you remember that?
Like you're gonna peel your skin off, fry your brain. Yeah.
So then, to the credit of these incredible researchers like Robin Carhartt Harris and Roland Griffiths, and all these people who are doing such responsible research in places like NYU and Johns Hopkins and UCLA and then I think Imperial College of London. They're doing such meticulous judicious research to basically be like, to help us see that they are in fact really potentially beneficial and safe. And not in all cases, not in all indications. There still needs to be proper setting and screening. And I don't think it's for every brain. I don't see that just… medical legal cautious perspective.
Sure. It's like any medication. It's not for everyone. Exactly.
But it is for some people and I think the field of mental health is in crisis. Our current menu of offerings is a little unsatisfactory. And some people are helped by it great hallelujah. But a lot of people, millions of people are not for one reason or another so we need more options. And I like psychedelics partly because they're reminiscent of some of the ways that our current offerings help people. They're active at the serotonin receptors, particularly something called the Five HT2A receptor, they promote something called BDNF or brain derived neurotrophic factor, which is very psychobabble for they can help with neurogenesis, neuroplasticity. They can help your brain grow and change and adapt. They do a lot of other really interesting things. The part about it that I'm most excited about is that there's something called the mystical experience hypothesis, which posits that the more peak mystical experience that you have in a psychedelic ceremony, that actually the more effective they are as a medicine, more enduring antidepressant effect. And so this has been borne out in the research. And I think that's really interesting, because it tells us, this is not just a biochemical phenomenon. Like you take this pill, and now you've improved the biochemistry in your brain, that tells us that there's something in the experience of the ceremony that's doing something to our perspective, to our framing, to our understanding of what this human experience and existence is. And so basically, I like that. And I like the way my colleague Will Soo puts it. He says, psychedelics are not just tools for healing trauma, they're agents for making spirituality palatable to our starving Western world.
I love that so much. I did a whole theme on spirituality and I had someone on who talked about deconstruction, and I got a lot of really positive feedback. And I was a little worried that I'm like, oh my gosh, my listeners gonna think I'm like, anti-Christian. And I'm not. I just, I've been through my own spiritual transition. And I was so happy that people were DMing me and like, I've never even heard the word deconstruction. So all that to say, I think that we are at a place where people are wanting something different, but they don't even know what that looks like, because we don't have that many options. And so I'm excited for that, too. Thanks for sharing that.
It's a fun place on the curve to be right? If some people were sort of raised with or organized religion shoved down their throat, and they kind of have been in a lifelong Kumari of that, they're just like rebelling from that it didn't align with their values. I was sort of came of age without any spirituality where I grew up, Atheism was cool. You know, if you didn't talk about God, that was like not, it wasn't a great you grew up, you grew up in New York, and then New York suburbs. Basically, like you would hear about God on the Country Music Station, and you would quickly turn the dial because that was not what you listened to. And so I was like, you know, obviously, I don't believe in God, that, no, dude, that would be ridiculous. And it had to come to me in my 30s to really be like, well, you know, but do I believe in something? And I really explored and figured out for myself, what form of spirituality feels true for me.
And I really like to help my patients like facilitate a seeking. I don't have any skin in the game, I don't need them to believe in something or, you know, take the accept the tenets of a certain religion, it's more like I want to make sure we're at least reflecting asking the questions for ourselves. And if we come up and say, like, nope, this is an extreme, you know, completely material existence exactly as the scientific laws demonstrate, like, that's a cool answer. But if someone feels like, well, maybe there's something vastly beyond our comprehension happening here. That's also a cool answer. And everything in between. And I think sometimes with anxiety, it actually can soften the edges a little bit. Sometimes when we do invite in the possibility that something beyond our understanding is occurring, it makes that worst case scenario feel a little bit less absolute and sometimes we can get some comfort, and meaning from the unfolding of the events in our lives, if we see it as not just random.
I agree with that. I think it's a normal human, just part of our biology to want to know that our life has meaning, want to know that we have purpose and that we matter and, and some kind of spirituality. Maybe we need another word for it. Just something beyond and bigger than ourselves. It's just part of being human. It's part of common humanity. And I love that the definition is sort of expanding. That's so fascinating.
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I know a decent amount of your work and like how you feel about certain things. But what are your controversial views on sunshine?
So I think we got sunshine wrong. I think we're about to swing in the other direction. So basically, we are the children of the 70s, the 80s.
Where the ozone layer was better, right?
It's true. But we were all taught to fear the sun and increasingly with each passing year, basically, that you know the sun is dangerous and harmful and can cause skin cancer and so we need to religiously slather our bodies in sunscreen. And I don't deny that there are risks with sunburn, certainly. And it's very individual. It has to do with your own personal family history of skin cancer. And was it melanoma, was it on a sun exposed surface. All these are considerations. How melanated is your skin, what's your own personal history of sunburns. All of this factors in but it's not a one size fits all conversation. And I think we've been doing a disservice to people with more melanated skin. And so if your skin is melanated for the Equator, and you're living in Chicago, and you work indoors nine to five, I personally believe that you're at greater risk from the vitamin D deficiency that results from being cautious around the sun, then you are at risk for us sun-associated skin cancer.
So I think we've just got it a little bit wrong. And we need to invite in a nuanced conversation about healthy amounts of sun exposure and what's a healthy way to get chronic low grade sun exposure. And it goes beyond vitamin D. That's what we're always focused on and that's something we can supplement with. But I don't think it's the whole story of how our bodies benefit from the sun. There are other photo products that we secrete in response to sun exposure and they impact our mood and our energy and our sleep and our circadian rhythm, and even our pain response and our blood pressure. So there's a lot we're getting from the sun, and I think a lot of us are unwell and even unhappy because we are avoiding the sun at all costs.
Interesting. I thought you were going to be like I think we should be indoors and just go live underground like moles.
I think we should be homesteading in Costa Rica and raising chickens and throwing our phone in the ocean.
Conditioning our hair in the river.
Shifting gears again, like let's talk about body positivity because you have a nuanced view on that as well. I'm super curious about it.
Yeah. So with this one… This one is so sensitive. So I'm going to do my best to kind of set the stage here. I am in the so-called toxic wellness industrial complex, right? I've already dropped spiritual bypassing, right, so let's go further. So like oh, everything happens for a reason make meaning from the unfolding of the events in your life. So I think that the journey here is that I was binging and had PCOS and all these other issues with my body. And for me, it turns out, I had to identify that I was addicted to certain foods, the drug like foods. Foods like gluten, dairy, sugar, and all of the flavor crystals on the Frankenfoods. All of the processed. And for me I couldn't of course abstain from eating but by abstaining from these drug-like foods, that was my exit ramp from binging and that actually is what allowed my body to heal. And I started to get my period again, I started to poop again, I didn't get ocular migraines anymore, I didn't have acne anymore. It was really the beginning of my journey of healing my body and my mood. And so then I was like, okay, now I'm a psychiatrist, let me help other people. Let me expedite their process for them. And I started recommending to my patients to abstain from some of these drug-like foods, and it's helped many people.
But I've also observed that it takes people down the path towards orthorexia where they become…
Please explain what that is for people that don't know.
So it's this obsession with eating in right way. And those are the people that start to decline social engagements, they stay home and meal prep and start to fear food and start to feel like their body is fragile. And it is just another form of an eating disorder in many ways. Now there's a deep philosophical question to have around or discussion to have around the fact that we only need orthorexia because our food system is so loveless and poisonous that it sets people up for this problem. But I digress. And so then what you see these days is a body positivity movement, which is really pushing back certainly against toxic wellness, but also against all of this sort of, patriarchal lens of here's what we want a female body to look like. Keep herself small, be thin, I don't care that it's unrealistic, like, deprive yourself of the joys of eating so that you know you fit into low rise jeans and look good and da da da. And so hallelujah, there's a movement to push back against this right? And it's really a reclamation of our ability to love ourselves and accept ourselves and enjoy our food and enjoy our lives. And I love the spirit of that.
In practice, sometimes what you see is that people run from orthorexia and from toxic wellness and clean eating all the way into the arms of what my friend Elise calls eating like a teenager. And basically then we just have run and run away from the toxic patriarchy of wellness and run right into the toxic patriarchy of the processed food industry. And we've become their champion really, they say treat yourself and they're selling us hyper-palatable ultra-processed addictive foods and we say, fuck it I'm not gonna keep depriving myself I'm gonna eat, I'm gonna let this go. And then we're, we're binging on candy bars or whatever, you know, whatever is our addiction of choice. And I think we don't land in a healthy middle, where we're feeding ourselves from a place of radical self-love. Which looks a lot more like nourishing ourselves. It's not avoiding heavier foods, you know, it's not like, oh, all I do is eat chia seeds, and arugula. But it's also not all I do is eat Snickers bars and doughnuts. It's something in the middle where we say because I love myself, and because I want to feel good. I'm going to feed myself nourishing food. And I think we're not there yet. We're still in the pendulum swing away from clean eating toward saying fuck it. And I think that's actually not creating wellness either. And I've had patients who come to me and have basically said, like, you know, I am a champion of the body positivity movement. I don't want to do any dietary restrictions. But they're suffering. They have… They're not getting their period, they have PCOS, they have endometriosis, they are struggling with knee pain from carrying around excessive weight, they are struggling with fertility, and certainly with depression and anxiety. And that's why this matters, is that I want people to feel well, where their physical health is just a foundation in the background that allows them to carry out their version of a fulfilling life. And I think that doesn't happen with orthorexia and it also doesn't happen when we're eating like a teenager. So we need to bring back feeding ourselves from a place of radical self-love, and that looks a little bit different and a little bit more wholesome.
I appreciate that. And I don't talk about my own, you know, nutritional habits or because it's just, a) it's not my lane, and b), I've still got some hills to climb on that. I did. I've talked a little bit about I struggled with an eating disorder when I was in my 20s but I still got my period. So it was like kind of like, not good enough to get diagnosed, but also, it was bad enough where you know, I would go to bed with my heart racing, my hair was falling out. My restriction was pretty dangerous. It was dangerous and plus the amount that I was exercising and which is thankfully those symptoms are behind me. And to be honest, like not to sound like a like an 11 year old boy but like I got to the point in my 40s where it's like I just want to be able to poop like regularly so fiber like oh my gosh. If you eat oatmeal I do overnight oats with chia seeds and what is the other one I have a mixed up in a container. Flax seeds. I'm telling you, anybody listening, that struggle with conservation, do that in the morning and you'll be fine drink a lot of water too. Otherwise it's not it's bad news bears.
But I also when you talked about like being addicted to certain foods. I usually only buy them in the summer like when we're going to the beach or to the pool or something Pizza Pringles. Stop it. Like you'll pry those out of my cold dead hands. But so my question…Iit which brings me to the question, and I do feel in a way I've dodged a bullet in terms of like binge eating disorder where I get sick, I feel physically ill and it will stop me. But you know, I did not dodge that bullet when it came to drugs and alcohol. What is considered sort of dangerous or something you should look at in terms of binging?
Binging doesn't is not typically acutely dangerous in the short term. Now there are people that binge and purge and purging behaviors can begin to be dangerous if you're sure if you're regularly vomiting, then that can start to affect electrolyte levels and predispose even for things like seizures and that can be dangerous. But if you're simply binging the danger is in long term. It's this slow burn of contributing to insulin resistance, type two diabetes, and everything that comes with that heart disease, and it's that can be a carcinogenic state. So it's a slow danger. I think the acute danger is really just the impact on mood.
When I was binging. You think that'd be fun, because no holds bar, I would just eat everything that I craved. But I was not pooping, which is miserable, and I was so isolated, and it was a shameful state for me, and physically uncomfortable and so sad. And I think a lot of people are stuck in this bind. And I blame the food industry. I think that this actually has to do with the fact that our foods are engineered to be hyper-palatable. They really kind of hijack our reward circuitry in our brain and overrule satiety signals, like the Pringles.
So that's why I can eat like 12 Pringles and put it back in the pantry and then turn around and leave. And then I'm like, but I want more.
Well they say you can't eat just one.
And they were not joking. Like that was on fire. That was by design.
The joke is on us plausible deniability. They told us exactly what they're doing. They're engineering it to be addictive. And that, I think, is actually, what's at the very heart of this debate between orthorexia and body positivity. We're over here warring and being like no my ways, right, no my ways, right. But we're all fighting because our food is not just food anymore. We can't just eat and be well. That's actually an… You have to eat intentionally. And it's an uphill battle to do that in the modern food landscape to actually eat in a way that nourishes your body creates a tidy, doesn't hijack your turn into a drug like relationship to food.
And so I think that that's really the problem here. And I think a lot of eating disorders actually start from the fact that we addicted the body to food, and people react to that in a variety of different ways whether it's binging or restricting and trying to control. It starts with the fact that we sense a feeling of out-of-control illness. And that's because we really have lost our satiety signals with these ultra-processed foods.
That makes a whole lot of sense. All right, and want to switch gears again, I know we're bouncing all over the place. And this because I have so many questions. Can we talk about sleep. Like how can we realist…and I know that you're gonna talk about phones. That's my guess. How can we realistically improve sleep? So give us the one two threes.
First the discipline 123. Now we're getting a 20 minute TED talk. You know it. So first and foremost, we have to recognize that sleep is one of our most important medicines for all mental health issues. It's a two-way street. We know that depression, anxiety, bipolar, ADHD, it all impacts our sleep, we know that like we're anxious, we struggle with sleep, but we need to recognize it's a two way street. And sleep also improves all of these conditions. And that's actually the easier entry point. We can get strategic and fix our sleep. I operate under the hypothesis that your body knows how to sleep, your body wants to sleep, it's not sleeping well because of these aspects of modern life that completely jack up our circadian rhythm and it makes it hard to sleep.
The main issue here is life. Our whole circadian rhythm or sleep wake cycle is cued by light. And that was a foolproof system on the proverbial Savanna of evolution where if it was laid out, that meant it was by definition daytime. So it makes sense for light to cause our body to release cortisol or stress hormone and we can feel awake and alert and meet the challenges of our day. And then if it was nighttime, it was by definition, dark. Safer, little fires and moonlight don't disrupt our melatonin release. And that authentic, reliable, convincing darkness tells our brain the super key asthmatic nucleus in our brain that's always scanning the landscape looking for light cues to know what time of day it is, it tells our brain it's nighttime, and then we suppress the cortisol, we release the melatonin and we feel sleepy and we can fall asleep. That system worked, and then we invented the light bulb, no shade, that's been helpful. But then we have the phone and we have the Netflix we had the Tiger King and the TikTok and nobody sleeps anymore. So the trouble is, is that we're seeing light after sunset. That's the main problem. And if we want to fix our sleep, we have to fix our light cues. It starts first thing in the morning and it just means you have to get actual sunshine into your actual eyeballs to start the clock. That's what helps you feel awake during the day and it also ticks in the background helping you get sleepy at night. So people are calling this a circadian walk. And pro tip if you happen to wear glasses with blue blocking lenses, you actually want to take off those glasses. Take off sunglasses, make sure it's actual sunshine, getting interactional. Don’t stare straight at the sun but you know, blink blink in that general area. And then and then the real magic happens after sunset. And no one can see this at home. But you can appreciate that I like to wear these ridiculous looking…
Stop it right now. Okay, you guys can't see this but she's wearing like those old lady glasses. All you need is a visor and like go to bingo. Can I please take a picture?
Let's do it. Got the greasy hair, the bed in the background, another orange glasses for this level of time.
Oh, okay. I will write myself a note to post that in my stories when this episode airs.,
And so basically these orange glasses that look ridiculous, they look like you're about to do metallurgy or go to bingo as Iran, they block all blue spectrum light from getting into your eyes. It's not a full free pass to scroll and zoom scroll and look at TikTok until one in the morning. But at the very least it will protect your melatonin release, so that you can still get sleepy at night. So my use case is I actually put these on at sunset, I wear them until bedtime. Some of my patients prefer to just put them on the last half hour or hour before bed and that's okay too. You figure out for yourself how sensitive to light are you. But this is a great way to protect your circadian rhythm.
And the last thing as you anticipated, is to just not bring your phone into your bedroom at night. Doesn't get to live on the bedside table while you sleep, you don't get to like hold it clutched to your chest throughout the middle of the night. Basically, you kiss your phone, good night. Phone, I love you, I'm gonna miss you. And you plug it in and it's charged or somewhere else in your home around 9, maybe 930, and then you enter this phone free bedroom and you read a paper book or you have sex or you meditate or do some stretches or take an epsom salt bath. For you do something not on your phone for that last bit of time before sleep. That helps protect your circadian rhythm. It helps you not get sucked into the endless scroll of social media which has no stopping cues to help us be like oh look, I got to the end of TikTok it's time to get right at this wholesome hour. There's no end and then also it prevents the Doom scrolling effect which makes us feel surrounded by danger which is relevant during the day you want to stay informed and part of the conversation. But at bedtime, you actually want to convince yourself you're safe so that you can surrender into deep sleep.
Well, okay. Which brings me to the question about insomnia. As someone who struggled with insomnia, sometimes to the point where I will not fall… I will stay up the entire night. That is very few and far between now, thankfully. But I have noticed that when I have times of increased anxiety, my insomnia tends to kick up and sometimes I feel like there's no rhyme or reason. I'll just have insomnia for several nights in a row.
So much rhyme and reason. So hormones are the sort of without which… Perimenopausal sleep is just a tricky biscuit. And there's no real solution to this. We have no way of evolving to have adaptive patients to perimenopause because it's by definition post reproductive. So if one lucky lady had a mutation that was like she had a better menopause, there's no way to select for that and to make her more fit and have more successful offspring because she has that moment exactly the same time later. It's not reproducing. Perimenopause is just shitty, and that will impact sleep. And it will be a more pronounced impact typically in the luteal phase of your cycle like the two weeks before you bleed. And then and increasing kind of crescendoing as you get closer to your period. Full moons are actually a factor. So sometimes that can just take the drama out of it to be like, I can't sleep. Oh, it's a full moon. Okay, let me just embrace
That happened to me last time, it was just a few days ago, and someone reminded me that it was a full…
Exactly. This is actually validated, like ER’s have more mania on the full moon, like people struggle more around the full moon. So to actually just accept it and embrace it and say, this is just a night I'm not going to sleep well and go with it. And then there's a lot to do to hack for unnecessary insomnia. As we talked about no phone in the bedroom, fixing your light cues helps a lot, caffeine is something worth being strategic about pushing a little earlier in the day, decrease the overall amount, maybe you're doing half caf instead of full caf. Basically, caffeine has a long half-life. There's still a lot of it buzzing around our brains when we're asleep at night. Alcohol is its own whole conversation, but basically it disrupts our sleep architecture. So and this has a lot to do with how our brain restores homeostasis after we drink and drinking rushes our brain with gaba, it's the neurotransmitter that's calming. That's why we love it. But our brain is like, oh shit, if a leopard were to come around, we'd be too buzzed. care. So let's quickly furiously convert this gaba to a different neurotransmitter called glutamate, which is an excitatory neurotransmitter. And that's why after we've had a couple glasses of wine at dinner at 2am, we're suddenly up, we have kind of a headache, we're tossing and turning, we're our heart is racing, we're in a panic, that's a glutamate effect. And so taking nights off from drinking can be helpful.
And then I think it's really powerful to just be aware of the fact that the existence of something called middle sleep, which is a very poorly named term, because it should be called middle wake up. But basically, there's a normal physiologic wake up between two equal blocks asleep. So if you go to bed at 10pm, and you need eight hours of sleep, this is math right on the spot, then I think around 2am, waking up, and your body probably needs to pee, needs a sip of water, roll to the other side, and then fall back asleep. But what happens instead is first of all, we glance at our phone so we give our brain a shot of light that tells our brain the morning the sun is rising, even though it's 2am and then we lie there and we think, Oh no, I'm up in the middle of night. Oh, no, it's a bad night of sleep, tomorrow's gonna be a bad day. And it's that narrative, we tell ourselves, that actually gins up our stress response and makes it hard to fall asleep, it becomes a self-fulfilling prophecy. So next time this happens, you wake up at 2am and you're like, oh, that fast-talking doctor on the podcast like that she was dying in the middle sleep. That's what this is. So basically, remind yourself it's middle sleep, try to do a squinty shuffle to the bathroom and then he was going to shuffle a sip of water and then you lie in the dark with your eyes closed, might take 10 minutes might take 20 to 30 minutes, but reassure yourself, this is middle sleep, I'm going to naturally fall back asleep as provided that I'm not in my late luteal phase perimenopause, and it's the full moon. But under normal circumstances, you're gonna fall back asleep and just trust that.
That actually helps me during insomnia, because then the other way of like stressing out and worrying about how many hours I'm gonna get that doesn't help at all. So I tell myself the same thing and I do this squinty shuffle. Because I know that if I turn the light on in the bathroom, forget it. So I just kind of do like the blind like feeling around to make sure I don't fall in the toilet.
Okay, I'm gonna ask you one more thing and I think this is setting a record for how many questions I actually got in without talking myself. But circling back to postpartum depression and anxiety, and I know, you know, there are some, some mothers listening to this and maybe who are who are in that phase or have gone through it. And can you just kind of like talk about the science behind that? I just… I also, I wish, in retrospect, I wish I would have been better prepared, because I was my first baby and I also, I just didn't even think that it could be a possibility. And my anxiety was so bad to the point where I couldn't drive. I was having panic attacks in the car, especially on certain parts of the freeway and I have this brand new baby, I'm a brand new mom and it was I had to I was put on disability like it was, it was pretty bad. And so I mean, what's happening? The way that I wanted to know how my doctor described it, to me, it's very layman's terms. And she said, it's kind of as if you are on the freeway, and then you throw your car in reverse, like that's gonna, you know, mess up your transmission, like your hormones are shifting a lot. And I'm that's how she described it. So that's kind of stuck with me.
Where the conversation is already at I support, I agree with. First of all, to take this very seriously, to really just honor this struggle and suffering, it's very real. There's nothing to be ashamed of, it's certainly not a cause for guilt, to recognize that you're worthy of getting help. You're deserving of getting help. And I agree with all of that and that's sort of where the conversation currently is. What it means to get help, I sometimes think we need a longer menu of options. Here's my hot take, because I always have to have like some heterodox view on everything. And I think when it comes to postpartum anxiety, we're so focused on…we just say like it is it happens, it's the hormones and, and I think we're overlooking another really impactful factor, which is the immense amount of nutritional depletion that happens in the postpartum period. So basically, we just grew a baby birthed a baby, sometimes it's quite a lot of blood loss, we might even…
A whole human, like, that still blows my mind.
And there's a system there's a triage in your nutrient stores in making sure the best stuff goes to the fetus. And then we might even be feeding a baby from our body and doing all of this against a backdrop of chronic sleep deprivation and a hormonal crash, not to mention the role transition and the fights with our partners and the oh, this was harder than I expected it to be and oh in my bed. The isolation, isolation and the struggles with nursing and latch and so on and so forth. It's such a hard time. But we are overlooking an actionable piece of this puzzle, which is the fact that we're so depleted. And under In the best of circumstances, like a nutrient dense diet that's being served to three meals a day, it still takes a while to replete those nutrients stores.
So part of what's happening with postpartum anxiety is just a brain communicating, I don't have all the raw materials that I need to function. And I think part of what we can do is support that nutritional repletion process as much as we can. The tricky thing here is that repeating nutrient stores requires nutrient dense, balanced, diverse meals and that's exactly what a new mom doesn't have time or energy to do. Or really any of us. Or can't afford it. And so we need somehow a system where you're getting support with nourishing your body, whether that's a mom or a mother-in-law, or a sister or a friend, or your community or a meal delivery service, or a TaskRabbit who comes in and chops food once a week. But somehow, there's nutrient dense food, landing on your lap three times a day, and you're not the one doing the primary amount of effort involved. And to really focus on nutrient density. And what I mean is things like organ meats, chicken, liver pate, bone broth, bone marrow, making sure that we're getting like these broths and stews that help us rebuild. And egg yolks and red meat even. And lots of healthy fats, we just need to rebuild, rebuild. And the more expeditiously we can do that, the sooner the brain comes back online and is able to function properly. And so that's I think, one unexplored avenue for a lot of folks is just to make sure we're supporting your nutrient stores to help you have less anxiety in the postpartum period.
Interesting that whole time was a blur, I don't remember how I was eating, but it certainly wasn't as nutrient dense as you described. So I'm sure it was a combination of things, you know, family history of, of mental health challenges, and nutrition and past trauma and all of those things. And a really difficult, difficult birth.
I hate that I have to come to a close, but I've taken so much of your time, I appreciate you so much. I know that you've said a lot but is there anything that you want to touch back on that maybe you forgot, or that you wanted to tack onto?
Well, I realize now that I've spent this time speaking at 1.25x speed and covering all these, like, you got to do this, and you got to do that. And for someone listening right now who's struggling with anxiety, I think I can have even a somewhat of an anxiety conducive effect on them. And so I want to remind people think of this as a buffet. Like we just laid out a lot of different options. My goal in coming at people with so many different ideas is to make sure that they have the actionable strategies they can take, and to realize that there's always hope. Because sometimes people feel like I've tried everything, nothing has helped and now I'm starting to despair. And we never run out of strategies we can do.
Your brain wants to function, it's your birthright to feel well, but this modern environment, with our traumas, with our inflammatory foods with our nutritionally bankrupt foods with our blue light after sunset, this environment sets us up to be anxious. And so we always have options to take to support that. But you don't need to feel overwhelmed by it. Think of it as a buffet reach for what resonates. So it feels accessible, that's where you start, maybe you make a little bit of incremental progress, and the next change starts to feel within reach. And you don't need to boil the whole ocean at once, certainly.
And if there's one thing that just cancels everything out and is more important than anything else you could possibly discuss from birth control to keeping your phone on your bedside table to nutrient dense food, it's actually community. And that's probably our most potent medicine of all. And it really just means you figure out for yourself, what, what really supports you. And one person might be extroverted, and they liked the networking event in the happy hour in the small talk in the elevator, and someone else's like that sounds like hell on earth to me, and I really just like a one-on-one conversation in a quiet park while walking. And that's great. There's no better or worse. But as human beings, we're a social species. We were not the fastest or the strongest species on the Savanna, we were just the ones that figured out how to cooperate. And that's why we survived and I think it's for that reason that it's in our hardwiring, that when we feel socially connected and held by community, we feel safe. And when we feel isolated, disconnected, ostracized, on some level in our DNA, it feels like it's a matter of life or death. So we can't let this one we can't overlook this factor. We need to be prioritizing what kind of community fills us up and building that into our lives.
Amen. Or word to your mother. Like however you want to organize your religion. Where do you want to send people? I know you let me just tell everybody the book is The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response. So on your website is ElleVora.com. Right?
And that's where you want people to go to find more of you.
People can go to my website, if they want to sign up for my newsletter, that's where I'm gonna announce when I'm doing an online group.
I'm so glad you're gonna do that.
Me too. I'm excited for that. It's time to make this approach more accessible. And my book is my life's work in 250 pages and I'm @EllenVoraMD on Instagram, where I'm…
You are really great on Instagram. I follow you there. So we'll have all those links in the show notes. Thank you so much for your time this afternoon. I appreciate it so much. And I'm so glad… I'm so honored that I can call you a friend now.
Likewise, Andrea, thanks for doing what you do. Your podcast is incredible and I'm so glad to be on it.
Thank you, everyone. Thank you so much for your time. You know how grateful I am that you choose to spend it with. We're here with me and my listeners. And remember, it's our life's journey to make ourselves better humans and our life's responsibility to make the world a better place. Bye for now.
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