Dhru Purohit Show - 3 Things You Can Do Right Now to Beat Anxiety with Dr. Ellen Vora

Episode Date: June 9, 2022

This episode is brought to you by Thrive Market and InsideTracker. Blood sugar is starting to get more of the attention it deserves in terms of optimizing metabolic health, but there’s one issue that often gets left out of the equation—anxiety.  The way our blood sugar, insulin, and other hormones respond to sugar and starch wreaks havoc on our mental and emotional wellness. Yet most people struggling with anxiety and depression are given medications without any consideration of their diet and lifestyle choices. Today on The Dhru Purohit Podcast, Dhru sits down with Dr. Ellen Vora to talk about the hidden root causes of anxiety.  Dr. Vora is a board-certified psychiatrist, acupuncturist, yoga teacher, and author of The Anatomy of Anxiety. 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.  In this episode, we dive into:    -The hidden root causes of anxiety (2:11) -The connection between blood sugar dysregulation and anxiety (4:15)  -Women, intermittent fasting, and anxiety (15:39)  -Caffeine consumption and anxiety (25:07) -Social isolation and the importance of creating community (30:02) -Understanding psychiatric medication in treating anxiety (41:52) -Using breath work to treat anxiety (1:05:09) -Tools to help mitigate anxiety (1:13:48) -False anxiety vs. true anxiety (1:23:45)  -The role psychedelics play in treating anxiety (1:28:22)  Also mentioned in this episode: -4-7-8 Breathing Technique -Amma (Extended Mix) by James Asher  For more on Dr. Ellen Vora, follow her on Instagram @ellenvoramd, Facebook @ellenvoramd, TikTok @ellenvoramd, YouTube @ellenvoramd, and through her website, ellenvora.com. Get her book, The Anatomy of Anxiety: Understanding and Overcoming the Body's Fear Response, here. This episode is brought to you by Thrive Market and InsideTracker. Thrive Market is an online membership-based grocery store that makes eating well convenient and more affordable. Join today at thrivemarket.com/dhru to receive an extra $80 of free groceries off with your first order. InsideTracker provides detailed nutrition and lifestyle guidance based on your individual needs. Right now, they’re offering my podcast community 20% off. Just go to insidetracker.com/DHRU to get your discount and try it out for yourself. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

We are not quite talking enough yet about the role that blood sugar swings play in anxiety. In real time, moment to moment, when your blood sugar is crashing, it's inducing a stress response, which can feel identical to anxiety and even panic. Welcome to the Drew Perot podcast. Each week we explore the inner workings of the brain and the body with one of the brightest minds in wellness, medicine, and mindset. This week's guest is Dr. Ellen Vora. Dr. Vora is a board-certified psychiatrist. psychiatrist, acupuncturist, yoga teacher, and author of the newly published book, The Anatomy of

Anxiety. And if you struggle with anxiety, even a little bit of pervasive anxiety in your life that you're not sure how to kick, this episode is for you. Dr. Vora takes a systems-based functional medicine approach to anxiety, which means understanding that anxiety is not something that just lives in the brain. It lives in the body. and there are things, multiple things that people do every single day, habits that you're used to, no shade thrown on your routine, but there's things that we're doing every single day that we have no idea are influencing our anxiety for the worse. But just like we can influence our anxiety for the worse, we can also influence it for the better.

And that's what we'll be talking about today on our episode with Dr. Ellen Vora. A little bit more about Dr. Vora. She received her BA from Yale University and her MD from Columbia University. She's completely changing the game when it comes to our approach to mental health. And on today's episode, I hope you walk away with a few key gems to help you in your journey to minimize the anxiety in your life or the lives of people that you love around you. Stay tuned for a fantastic episode. Dr. Ellen Vora, welcome to the Drew Prow podcast. It's a pleasure, honor to have you here.

Before we unpack your story and your whole radically different approach to mental health, including things like anxiety and depression and so much more, I want to start off with what do you think are the top hidden, even for some of our audience members that are pretty in the know about wellness and brain health? What do you think are some of the top hidden causes, root causes of anxiety that are often being overlooked? Ooh, love it. Okay, hi, Drew. Thanks for having me.

Top hidden causes of anxiety. Hmm. I think we are not quite talking enough yet about the role that blood sugar swings play in anxiety. We're talking about blood sugar, and we're starting to appreciate its role in longevity and brain health, dementia prevention, weight management, all of that. We also need to appreciate that in real time, moment to moment, when your blood sugar is crashing, it's inducing a stress response, which can feel identical. to anxiety and even panic.

I would also say that just our exposure to blue spectrum light after sunset is playing a role directly and indirectly in our anxiety levels by way of suppressing our melatonin, disrupting our circadian rhythm. We're just not getting tired at the right time and sleeping deeply through the night because we're surrounded by the psychedelic light show of modernity after sunset and it's screwing with our circadian rhythm. And maybe the third one, this one is a tough nut to crack. It's like we can talk all day long about it, but the solutions are a little bit less prescriptive, less actionable, but it's our isolation.

It's our lack of community. Humans were never the fastest species or the strongest species. We were simply the ones that figured out how to cooperate. And for this reason, it's hardwired in our DNA that when we feel a sense of belonging, we feel connected to the group, we feel safe and at ease. And when we're socially isolated or feeling ostracized or disconnected, we feel anxious. We feel unease. So this is unavoidable. And in modern life, where we are using social media instead of in real life interactions

to scratch that edge of our social needs, I think we're missing these opportunities to give our nervous system a signal of safety. I want to unpack a couple of those topics. Let's start off with the first one. How is it that crashing and our blood sugar crashing, which if you could do a reminder, a little bit of a refresher course for our audience. We've done so many episodes on the topic of metabolic health, glucose, blood sugar, et cetera, but it's nice to have a refresher. So why does our blood sugar crash in the first place? And then what's the mechanism that that can feel like anxiety to a lot

of people? In fact, I know people today that identify, they wear as a badge of honor that they're an anxious person. And by simply fixing this one area, they are no longer. anxious. I'm not saying that's for everybody, but I've known people like that. So walk us through a little bit of that topic and help our audience understand what's going on there. I love giving this like high school biology lesson. So basically when we're eating foods that tend to spike our blood sugar and that's everything in our modern food environment. It's built on a foundation of refined carbohydrates and coffee drinks that are secretly milkshakes and rosé all day. We're eating these foods that spike our blood sugar and then our body sees that spike and we chase it with

insulin. And so then the insulin is causing all of our glucose to be absorbed into our fat cells, sometimes our muscle cells, and then what we find happens is then our blood sugar crashes. It's just sort of the slightly imperfect design of the body is that it's not like calculating and being like, we have this much blood sugar, so we should put out exactly this much insulin and then we will restore perfect levels of blood sugar. It's an overshoot. There's an antagonistic relationship between insulin and glucagon. And, you know, insulin can't really gauge exactly the right amount to throw at our blood sugar. It's more like it throws and then glucagon reacts and so on and so forth, kind of pinballs back and forth. And so what happens when we eat something

really sweet, we have a big hit of blood sugar, a big hit of insulin and then a big crash in our blood sugar. Our body responds in part by secreting our stress hormones, cortisol and adrenaline. It's a stress response. It just happens to be the design of the body. I don't think it's such a bad design. It creates urgency for us to forage for food. Food and starvation is a life or death issue on that proverbial savanna of evolution. But it's also the mechanism we have for queuing our liver to break down its storage of starch. So it keeps glycogen. And when adrenaline and cortisol signal, we have a blood sugar crash. The liver breaks down its glycogen stores. We restore our blood sugar to normal levels. Our organs don't fail, we live to see another day, it's a pretty decent design. It just happens to have

as a side effect, a fire of a stress response in our body. And that stress response can feel synonymous with anxiety, panic, feeling easily overwhelmed, or if this is happening overnight, waking up throughout the middle of the night. And this is creating a lot of unnecessary suffering. And you're right, and we can totally go into that philosophical conversation about the ways these days we identify subjectively with the term anxiety. It's part of our identity. But there's something a little, I think it's invalidating to feel like these things that are part of our anxiety and give us a strong sense of doom and gloom and color our whole perception

of our reality. If they could be caused by something seemingly so small and trivial like a blood sugar swing, you know, we feel sort of foolish. But I'm not here to shame anybody or make them feel foolish. I just want to reduce human suffering. So I want people who are struggling with anxiety to at least try to stabilize their blood sugar and see if it doesn't eliminate a lot of unnecessary suffering. I think one interesting thing that you said earlier.

I mean, you said a lot of interesting things. One that I want to highlight is that you mentioned when we eat something sweet. And you also opened up and you said, you know, often refined carbohydrates. I had a friend in my network who was one of those individuals that identified it as an anxious person. Again, no shade around that. We're going to be talking a lot more about those things later on in the interview. And she said, you know, I don't eat a lot of sweet things. But every so often, I'm like famished because I'm between meetings and I'll have a big bag of chips.

And yes, it's a bad habit, but it's not sweet. But help us understand how something like a big bag of chips is also essentially like having something sweet, like drinking a packet of sugar or drinking a soda. it's an equivalent thing. So important. Yeah. So, I mean, we have these concepts of sweet versus savory, but savory can still be starchy.

So just because the taste on our tongue is salt, it can be starch. So when it's a potato chip, that's ultimately a potato, which is starch, it's glycogen. It breaks down into glucose molecules. And so there are plenty of savory foods that are still starchy. And I'm not here to come down on carbohydrates as a whole. Like, in fact, it depends on my patient. It depends on many factors. But for the most part, I find that when I see people that are really plugged into the wellness world,

sometimes they're not eating enough carbohydrate, and I like to actually get them onto a little bit more carbohydrate to help with their anxiety levels. But starchy tubers, starchy vegetables, things that our body recognizes, things that are slower to digest and slower to be released into our bloodstream, that give us a nice more even gradual blood sugar curve, not the refined carbohydrates. So the important difference is not carbs are all evil, but eating a sweet potato, a plantain, taro, yucca, even white potatoes, especially if you're eating this long side healthy fats, this is a better way of giving carbohydrate to your body than the refined carbohydrates like chips and, sorry, like crackers and cookies and baked goods and all of that. So even if it's not actively like a piece of candy, it can still break down into glucose. You know, I've heard you talk on social media before that how we often start our day can help us set the tone for our mental health in a way. And give me a little bit of a compare and contrast, right? Let's say if you have a patient coming into your office, because you still see patients, right?

And they're telling you, and they're one of those people that has anxiety-ridden finds himself. Now, anxiety is a spectrum, and I'm sure you'll break it down. lot of different things that play a role into that. But since we're on the topic of food, let's say this is somebody whose anxiety is being impacted by the constant up and down of blood sugar throughout the day. What do you find typically is how that person starts off their morning, including their breakfast and whether or not they have breakfast in the first place? So what's going on in their routine that is contributing to some of these factors that might be playing a role in anxiety? We're in the moment right now. We're the hot thing to talk about in intermittent fasting.

and you see a lot of people really benefiting from it. It's a pretty male-dominated conversation, and I think for a good reason. And then you have a couple really wonderful voices of female physicians participating in the conversation and saying, well, here's where intermittent fasting can also be appropriate and beneficial for female patients. I think that when I have a post-menopausal woman in my practice, intermittent fasting can be really helpful. And part of why that's helpful for setting the tone and starting the day

is you're really retraining your metabolism. You become more flexible, a little bit less just sugar-dependent and constantly swinging up and down, up and down, like eating something and then craving and then eating and then craving. So you train your metabolism to be able to tolerate longer stretches without food, and you give your digestive track of rest, and you allow for a catabolism, and all this really nice cleansing that can happen when you're not actively digesting something. But I have a lot of patients in my practice who are females of reproductive age,

and intermittent fasting can be many different things. You know, it can just be circadian fasting where you stop eating around sunset and start eating around sunrise. And I think that's a lovely way for my women of reproductive age patients to eat. But when they start to play around with longer stretches of intermittent fasting,

what I've observed in my practice is that that's not doing their anxiety or their physiology in general any favors. So I've seen patients like that. Usually I'm patient with intermittent fasting. Sometimes you'll see somebody it's a little wobbly at the beginning and then they slowly find their balance. But in the case of these women of reproductive age, what I see more commonly is that their hair

starts falling out. They feel colder. They're not sleeping as well. They feel more anxious. Their period becomes irregular. So it just depends. I've also had female patients of reproductive age thrive with a longer intermittent fasting regimen. But overall, I think that the reproductive age female body is constantly assessing nutritional stores. It's assessing for abundance. It's saying, is this a good time to get pregnant or not? And if there's more of a signal of famine, which can have health benefits, but when we have more of that signal of famine, the body, the pituitary, the hypothalamus wisely says, well, this wouldn't be a good time to get pregnant. So let's shut down ovulation, and then we won't get pregnant. And that's all well and good. It's a smart

triage so that we're not building nutritionally deficient babies and we're not depleting the mama necessarily, but it does mean a state of hormonal imbalance, which can then impact things like hair growth and energy and mood and sleep. And so I've had many female, the reproductive age patients not do great on intermittent fasting. And I've also had some who do because human physiology is always designed to, you know, anytime we get dogmatically convinced of a certain opinion. It humbles us by showing us the opposite example. Well, I'm so excited to see you talk about that, not only online, but in your book, because we've had many of those physicians on this podcast talk about those nuances. My audience is probably a little bit more female dominated than some of the

podcasts that you've been on before, like our friends Max and Lewis. I think I probably have 90% audiences, is women. Shout out to all the amazing women that are out there listening. And so we've had a lot of experts come on this podcast talking about how we need to incorporate personalization because even in the case of women in the reproductive years, even if you have no intention of wanting to get pregnant or you're many years away from thinking about that component, we have to still understand that our biology, well, women's biology, not our biology, but women's biology is seeking to optimize for pregnancy. And when you put yourself in these high stress environments, you can have a whole cascading of effects.

You know, this is all part of the movement and wellness, which has been beautiful to see, of personalization and individualization. So I appreciate you championing the message. Talk to me about your approach to breakfast. I think one part of it is intermittent fasting, but another part of it is that I've noticed also the women in my life, including my wife, do much better when they have a little bit of fat fiber and protein in the morning as a way to ground themselves compared to the traditional high carbohydrate super starchy and orange juice based meal.

So I know you're a fan of oatmeal. So let's talk about your approach to that world. I think there's a lot of ways you can make oatmeal in a healthy way. So tell us what you like to do and what you recommend to your patients. You've done your homework. Yeah. You've learned about my breakfast choices. So I have patients certainly who are like, you know, and I think whether or not they're

inclined to admit it, they start the day, kind of skipping breakfast, kind of just getting coffee, and they're convinced that this is going to help them lose weight. And I find that A, no, but B, it really does set them up for a tone of anxiety through the day. It's basically like the ways our body gets energy is partly from nutrition. It's partly from rest. And I think a lot of my patients are on this vicious cycle of waking up sleep deprived, tired, not eating something, having coffee instead. And they're generating their anxiety from the day from cortisol, from our stress hormone.

And so it really does set them up for a tone of anxiety through the rest of the day. And I have a lot of patients where if they start the day anxious, it's very hard to recover and to ground their energy. It's almost like it stretches the rubber van and it snaps and it kind of keeps going back and forth. And I think that similarly with anybody who starts the day with just isolated refined carbohydrates, you're starting the day with a glucose spike and then it's going to start you on that roller coaster. I like to encourage people to start the day with things like eggs or, you know, really good quality

bacon or avocado and all of that. And when that works for someone, that's great. I always try to do that. You probably heard me on Max's podcast and, you know, he sort of had me there, like, on, you know, I was sitting in the court, you know, being like, I eat oatmeal for breakfast. I'm sorry. I'm in this functional medicine space, but I commit the cardinal sin of starting the day with this grain.

And so he convinced me to go home and eat my eggs and my bacon and my avocado. And the fact of the matter is it doesn't work for my body. Sometimes there's just more than what we know from the current research and what truly does work for my body is steel-cut oats. And that's what I eat every day and I've so happily come back to it. So steel-cut oats with cinnamon,

which has its blood sugar-stabilizing properties and some wild blueberries in it. And then I'll usually have some handful of nuts in it to sort of provide more of a blood sugar, stabilizing fat. So pecan pieces or sprouted almonds, things like that. That's what I eat. And I think we know our bodies. And if something really works for you, you can trust that even if it goes against what

the podcasts are telling us to do. Yeah, yeah. I'm a fan of steel cut oats. I like to have them occasionally. It's not my go-to. But another friend of mine, Dr. Casey Means, who's been on this podcast before, she loves starting the day off of oatmeal and has all these photos on her Instagram of different ways that she prepares it, adds a little bit of almond butter, adds sometimes some, you know,

even olive oil. People put something like olive oil and other things. I think you can make oatmeal in a lot of great ways. And, you know, this goes to a larger message, which is that if something works for you, you have some visibility long term on your labs, right, and what is heading in the optimal direction. You know how you feel and you've increased the connection between what you eat in this case or your activities and your lifestyle activities and how you feel. That's the most important thing because how is it? The audacity that we think, you know, human beings are so diverse, the audacity that there's one right way to go about something is kind of freaking nuts, right?

So it's so nuts. And I think like I really always prefer an ancestral perspective and baked within that is to understand where did our ancestors descend from? People tell me like, you know, is coconut oil healthy or unhealthy? And it's like, well, I think kind of healthy and the deductive reasoning that it's has saturated fat is therefore bad because we have these old debunk studies that show a saturated fat is bad. Like I don't take that bait. But I also think there probably is bioindividuality to how our bodies tolerate something like this. Did you descend from people who live near palm

trees and coconuts? Then probably your body loves this. And if you didn't, then it's more of a question mark. But yeah, the bio individuality piece is so central and audacity also to think that we've got it figured out today. We're all quick to jump on the fact that, oh, we had it wrong in the 90s with low fat. We had it wrong when we said avoid the egg yo can eat the egg white omelet. We had it wrong then. We had it wrong then. But today we've got it figured out. I think we've made incremental progress and improvement, but we're not fully there yet. You mentioned in my original question, you talked a little bit about caffeine and coffee. I want to talk about your relationship with it. But first, I want to talk about what education

you're providing to your patients especially who come in, you know, you're in New York. It's a very wired city. I used to live there before right on 22nd and Broadway, right by the Flatiron building. Loved it. Love my time there. It can seem like a very high, strong, very highly caffeinated city. What do you notice for your patients when it comes to having a better relationship with their caffeine consumption? Caffeine is not an inherently bad substance, coffee, is certainly not inherently bad. Tea has its polyphenols and antioxidants, coffee full of magnesium and antioxidants, like wonderful substances. We just have to acknowledge the bioindividuality. One person might be a rapid metabolizer of caffeine. They can have their espresso at the end of dinner

and go to sleep two hours later, no problem. Must be nice to be that guy. On the other hand, some of us are slow metabolizers. We're sensitive to caffeine, and I could have coffee last week and I still feel like I'm on cocaine. So it's, we just have to acknowledge that it's operating differently in our body. Caffeine has a relatively long half-life about five to seven hours, you know, call it about six hours, but we're variable. And if you struggle with insomnia, struggle with mood swing, struggle with insomnia, with anxiety, you just want to maybe open, step back and kind of consider should I push my caffeine consumption a little bit earlier in the day so that this long, half-life slow to metabolized substance isn't buzzing around my brain when I'm trying to

sleep well at night. And if you're sensitive to caffeine, maybe you want to decrease the overall amount. And a very important PSA here is you don't want to make any changes overnight, no cold turkey off of caffeine. It's a very real drug with a very real withdrawal. And so what you want to do is just make very gradual changes. Maybe you switch from full calf to like three-quarter calf, you know, one-quarter half-de-cafalf, and just gradually weaned down.

Maybe you get to black tea, maybe you get to green tea, and you just see where you're at, have your anxiety levels improved. And the last thing I'll just add about this is that nobody likes this conversation. I make no friends with this conversation because everyone's like, well, you know, the world sucks, but coffee, coffee, that is my one true friend in the world. It's my salvation.

And part of what's happening here is that coffee rescues us from caffeine withdrawal. Like, we're giving it credit. for saving us from a problem that it caused. And so we're giving it all this credit. And it is possible to live a life fully off of caffeine where you've re-centered your energy levels and you're not always in that relationship of I'm either in caffeine withdrawal

or I'm on caffeine and feeling good, where you just have eliminated that dynamic from your physiology. I had a mentor that told me a long time ago, one of my first mentors in the world of health and said, you know, shopping can be fun, right? Shopping can be fun, depending on what you're shopping for and your interest. But if you need a shop to function in the day, then we'd call that an addiction. And in that same way, I think the perspective on functional medicine is like, great, coffee has all these benefits, polyphenols, etc., other stuff.

And if you need it to function, there's usually an indication of something deeper that's going on that needs to be investigated. Now, transparently, I drink coffee and I enjoy it. And every so often we've written newsletter about this, done podcast episodes on it, I do, I take a coffee break. And it's one way for me. And it's never easy. And I have a whole ramp up process, not too dissimilar from what you mentioned, although instead of decaffeinated coffee, which I think tastes disgusting. I switch over to like Yeromonte, then to like a lighter green tea, then to like, you know, I have a whole like ramp down process. and that break is so helpful for me.

So it'll be like every two months, I'll take a break for about two weeks. Now, in general, I don't have more than a cup of coffee. A day, I have one cup and I'm good. And I've also, having done that coffee break, one of the things, because there are days where we can abuse things. Today was actually one of those days where I ate a little bit later. I drank a lot of coffee and I was running around

and I ended up having a second cup because I went to a meeting with a friend. One hack that I just want to share with the audience that I stole from Andrew Humerman when he was on the podcast previously here is when I get in that cracked out phase, right? Everybody knows that sort of you had a little bit too much and you're kind of a little bit wired. I basically, for every cup of coffee I've had, I have about five cups of water to help mitigate a little bit of that feeling. So my audience knows that a little bit. And I just wanted to bring it up in context because I think that thing, which is so. so important and why I value functional medicine doctors like yourself so much is because you never know how you can feel until you take a break from something and actually allow your body to show

you where it's at. So just hats off for recommending a coffee break to individuals. I think more of us could utilize it than, you know, think that they could benefit from it. Yeah. Yeah. I want to switch topics a little bit, and I want to go into another part of your answer for your opening question, and that was social isolation. Let's talk about community in your life. What does it look like and how do you get that love and connection from the closest people around you? What routines, clubs, processes have you done to hack modern life, which can really drive us towards more isolation? You know, I mean, part of it is my ambivalent relationship with where I live. which is New York City. And I want more nature in my life. I want more warmth in my winters.

But community kind of trumps all. And part of it is that my people are here. But part of it is that New York City is actually a place that really lends itself to community and connection. Because we're so socially dense here, we live within a walking distance to each other or a subway ride and it decreases the barrier to socialization. So I've really designed my life around community. And my apartment is effectively a co-working space and multiple of us sit here and you can hear in the background someone arriving right now. And so basically there's community in the day to day. And, you know, I married someone who is a connector. And so he never exists without like multiple people orbiting around him. And I think that part of what's been really important, especially as we've

gotten busier and we've had a kid, is to lower our standards. for social engagement. I know that some people feel a sense of obligation of if I'm going to have people over, here's what it's going to look like. I'm going to clean the house. I'm going to present myself nicely. I'm going to cook a meal. I'm going to, God forbid, bust out the fine china.

And like, this is a love language of here's how I show my guests that I care about them. And it's beautiful. And if you have the bandwidth for that, great. Have me over. I'm excited for that. But if you don't have the bandwidth for that, let that not be a barrier to social connection, which we can do in an entirely different way. The way we host in our household is we do not clean the house.

We do not take off sweatpants. We order takeout and gather people here in our home. And it's not fancy. It's not this huge act, but there's not a lot of prep that goes into it, not a lot of cleanup afterward. And this is what makes it realistic for us to socially connect all the time. and then we're able to be present. There's something very disarming about an informal setting

so that we can really just show up and authentically connect and be goofy and get real, and that's how we do it. And I think one other just part of how we need to be thinking about socialization right now, we're two plus years into this pandemic, so much political hyper-polarization, and we carry so much resentment and judgment of each other. for how everyone has made slightly different choices through the pandemic, has had different behaviors,

maybe had behaviors like this earlier on and then changing at this point. There's so much divide, and we need to bridge it. And I think that the only real way we bridge that divide with the people in our lives who matter to us is by accessing our capacity for empathy, compassion, understanding. We can't just carry around all this judgment and resentment. it's not serving us. We need to ask questions, try to understand other people's perspective, and keep doing that

incredibly difficult work of understanding like, okay, it's a different perspective. Everyone here thinks they're the good guy and to have compassion for each other as we're all trying to navigate this really impossible situation. I'll learn to talk about your origin story. As a psychiatrist, take us a little bit through the process of what originally inspired you to want to pursue that path. And what were the key factors in your story that had you have a completely different outlook on how to actually get to the root issues of people's mental health challenges,

disorders, diagnoses that they were suffering from? For me, it was two parallel processes where I was in crisis in terms of taking care of my patients because I saw how I was being trained to masterfully, medicate people. And so they'd come in and I'd start them on something and then they'd come back for a follow-up and kind of shrug like, yeah, I think I'm feeling a little better. And it's like, oh, let's increase the dose. Let's add this to deal with the side effect and sort of learning how to be a pharma jockey. But I would observe. My patients would turn around and walk out of the office and would scratch my head and think, okay, like I did the right thing according to the standard of care.

But does anybody here thriving? Are they leading fulfilling lives? Or did I just sort of patch a hole and it's slightly better than it was before, but it's not good. And so I was in crisis about this incredibly like blood, sweat and tears expense education that I had just gotten for a decade, and was it really all that helpful? And then the parallel crisis was my own health. And this is the beautiful cliche of everyone in the holistic or functional medicine space is like we don't get here from some aha moment that usually doesn't on some level pertain to our own health. So it's, It's an important credential. And basically, I was thinking I was doing everything right, eating right, exercising, right.

I was a doctor. I thought I knew how to create health. But my body was like this machine with the springs popping out. And I had polycystic over syndrome and acne and irregular periods and ocular migraines and joint pain and rashes. And I could not poop to save my life. And everything was breaking. And I would go see a gynecologist, a primary care doctor. and they'd be like, well, you're probably just stressed.

Let's put you on Prozac. Oh, you're not getting your period. Well, that's not good. We can't have that. Let's put you back on the pill. And I did not yet have the vocabulary to understand functional medicine. I didn't know root cause resolution versus symptom suppression. But something in me, it just did not sit right.

I was like, something about that doesn't seem right. Like, I'm the product of 500 generations or so of successful repressions. production, why would that stop with me? Why is my reproductive system broken? Seems funky. Seems like it might not be genetic. It might be environmental. And so I just knew to be questioning, but I did not yet know where to be heading. And perhaps an illustrative moment that really set me down a different path was in my surgery rotation in the third year of med school. We're standing around an appendectomy. And I'm asking the general surgeon, kind of just shooting the shit, because weirdly that's what you do in a surgery as you stand around and you're taking all these tedious steps and you're kind of just talking.

And I was like, what do you think causes appendicitis? And he shot me this glance and he really defensively was like, we don't ask why. We just cut. And that's all I needed to know. I was like, ah, okay, I don't belong here in conventional medicine because I'm a New York Jew. All I do is ask why. I'm a psychiatrist. Like, I just want to know why. I want to keep going more and more proximal to the root of the problem and understand why, what is contributing to a problem. And so when he said that, I was like, I get it now. Conventional Western medicine is designed to react. We cut. We say, oh, there is a tumor here. There is a problem here. There's been a heart attack. There's been a car accident. Let's react to it masterfully. And thank God for that. The heroic interventions that

conventional Western medicine is capable of doing to react to when the shit has already hit the fan is amazing and life-saving. But that's not what lights me up. I'm not interested in reacting. I'm interested in preventing. And so I realized that I belong in a slight variation on medicine. And that's what, you know, drove me into exploring Chinese medicine and acupuncture, Ayurveda. I became a yoga teacher. That's the cliche of any of these journeys.

And I studied nutrition and functional medicine, eventually psychedelic medicine. And that informs everything I do with patients and trying to identify where is somebody out of balance. How can we nudge them back into a state of balance? and obviate the need for medication and eliminate diagnoses that we think of as a destiny. You know, with all those experiences and that journey that you went on, were there a few fundamental distinctions? You know, you've kind of talked a little bit about this, but just to really solidify for the audience, were there a fundamental, like I used to look at the world

this way and now I look at the world this way. Let's say when it comes to especially mental health and things like anxiety, right? Were there any like clear-cut distinctions are like, okay, I used to look at this way or I was trained this way and now I see it this way? A couple of those key takeaways that you can share with us. Absolutely. And this will date me a little bit. But in the 90s, when the Dave Matthews band came out with their album, Remember Two

Things, the album cover of the CD was a magic eye poster. And you would stare at it and just look like this weird pattern. And you would stare and stare and stare. and then eventually you saw this image pop out. It was, spoiler alert, someone holding up a peace sign with their fingers. And once you saw it, you could not unsee it. And so you were never, again, going to just look at that strange pattern. You were always going to see the peace sign pop out.

And for me, that was the functional medicine kind of cardinal insight of, let's do root cause resolution rather than symptom suppression, rather than bandating. And within mental health, I had to have the revelation, which is I was, we came of age, indoctrinated with what's called the monoamine hypothesis of depression, thinking about our mood disorders as a result of our serotonin, our chemical imbalances, our neurotransmitters, and our brain, and that that was a genetic issue, that it's an inheritance. You have mental health, it runs in your family, you have a gene that imbalances your serotonin, and that's what's contributing to your depression and anxiety.

And I kind of accepted that gospel initially until I started to realize that the real determinants of our mental health include our genetic predisposition, sure, but it's only ever a predisposition. And as we say in functional medicine, genes loads the gun, environment pulls the trigger. Genes is not the part we can do a lot about. But the environmental piece, that's where we can do something. and there are all of these other determinants of our mental health, how inflamed we are, how well we're sleeping,

how nourished our bodies are, whether our blood sugar is rollercoasting around, how imbalance our hormones are, the state of our gut health, and not to mention all of these fundamental human needs, the psychospiritual determinants of our mental health, which also wasn't really taught to focus on in my training, but our fundamental need for community and connection,

for some sense of meaning or purpose in our lives, even for nature. And these are also determinants of our mental health. So I started to realize that if there is a chemical imbalance, it is often a downstream effect. And it's the result of some state of imbalance happening elsewhere in the body. Sometimes it's a physical state of imbalance. Sometimes it's a psychospiritual state of imbalance. But that's where the money is.

if we shift our focus away from this genetic chemical imbalance, there's not a whole lot we can do about other than Medicaid away. Let's look approximately. Let's look at what's creating imbalance. Address it there. And then we can really move the needle in terms of how someone's feeling. When it comes to prescription medication, you've shared before and inside of the book,

you talk about a lot of the layers around it. There tends to be a little bit of a black and white world out there. Some people are like, this is the answer. And all we have to do is increase access. And then other people, you know, sometimes in the holistic space saying this is absolutely not the answer. We need to look at all these other components that are there, right? Share your perspective as a practicing physician who's actually firsthand writing prescription medications first time and seeing both the impact but also the limitation.

Share that perspective with our audience if you would. Yeah, so like roll up your sleeves and strap on your nuanced seatbelt because it's a nuanced conversation and it's a sensitive topic. I think I was a bit more dogmatically anti-farma earlier on in my tenure as a psychiatrist. And, you know, like all good things, the practice of medicine, it kicks you in the teeth. Anytime you have a dogmatic viewpoint, it humbles you and shows you like, not this time though. And so I've learned over the years, like, you know, I'm a psychiatrist. I prescribe medication. I have patients on meds.

I have patients who we have worked tirelessly through every holistic strategy. And I believe in my bones that this is a viable strategy for them to find relief from their depression or their anxiety. And it hasn't been the thing. And then eventually we've put them on some medication. And that was actually the keys to the kingdom. So I am, you know, I exist in between these two worlds. But I am pretty, I'm just more excited about the holistic strategies, and it's for the following reason. If you're someone out there who has been helped by psych meds, this is great.

I count this as a victory. I don't see any shame in that. I don't think there should be any stigma. I don't think anybody who's helped by their meds should second guess it. If it's helping you count this as a victory, we're just in the business of decreasing human suffering. So that's great. And if that were the whole story, we could just end there. But there are millions of people for whom that is not an adequate solution for one reason or another.

Some of them started a med. It was helpful, but then the effect waned over time. Someone else might have tried every psychiatric medication under the sun, and they just feel chewed up and spit out by the field of psychiatry, and they're feeling hopeless. They feel really demoralized by that process. Someone else might have side effects. someone else might have a contraindication.

So it's to those millions of people who have not found an adequate solution in psych meds that I'm speaking to. And it's for those folks because if you're helped by your med, you don't really need me. You don't need someone taking a different approach to psychiatry. The existing approach works for you. But it's those other millions of people for whom it's not been adequately effective. I speak to them when I say, don't despair. There's reason for hope.

There are other paths up this mountain. and medication is one path up the mountain of healing. Therapy is another path. They work well together. But if those have not been the thing for you, we can think creatively about the millions of other paths. And I think that the two slightly more controversial things I'll say about meds. One is that for the most part,

I don't think mental health issues are a lexopro deficiency disorder. I think that that is a, I think eventually we will look back and think it's kind of absurd that we're thinking about it that way, the audacity, as you said earlier. We, our mental health issues are sometimes a result of chronic sleep deprivation from mouth breathing, from sleep apnea, from bad habits. Sometimes it's that we're inflamed. Sometimes it's our micronutrient deficiencies.

Sometimes it's a thyroid issue masquerading as mental health issues, sometimes a hormone issue. It can be so many things. Sometimes it's just that we're surrounded by assholes and we're not getting our fundamental human needs met. And so when we just slap Lexapro onto that really complex picture, we're sometimes barking up the wrong tree. We're missing the root cause of the problem. And I just have a compulsive need to find the elegant solution. Like what's really causing

this person's mental health issue? I want to identify that and address that and then obviate the need for medication. And the other slightly controversial thing to say about it is that we just don't have enough informed consent right now about the true efficacy. And I think even more damning is about the process of getting off of psych meds. We say, you know, I meet a problem. I mean a patient. I have 15 minutes with this person. They start crying in my office. Ah, make you go away. Here's a prescription for a medication. They'll be a happy camper. They'll think of me as a good doctor. Problem solved. And we don't have time, but we also don't have the training to have a conversation about the fact that, well, what's the exit strategy here? Like, you know, we're putting

you on this to help you with the ways that you're struggling. But then what if five years from now, you come back and you say, you know what, a lot of those stressors in my life have resolved and feeling better and want to get off this medication. And when somebody says that to their primary care doc or their psychiatrist, often they're met with resistance. The person says, well, you don't want to get off or I don't know how to do that properly or I don't support that. So people find themselves doing it without the support of their prescribing physician. They find themselves doing it in an unstructured way. So oftentimes people might taper a little bit, like have it for two weeks and then go off or just go cold turkey does not refill a prescription. And that is creating

so many problems. And I call it the silent epidemic where people are in acute and really severe withdrawal and not knowing to attribute it to withdrawal. So then people call it relapse. They, you know, they get off a med and about two months later. They feel terrible. Things get really dark. And they just think, well, I guess that medication was really working. I guess I really did need it because now I'm feeling terrible. Or they just blame themselves. They say, you know, I'm really broken. And they don't know to connect it to the medication. They don't know to call that withdrawal. And I think we need to have a public conversation about the fact that psych meds are very psychoactive, real drugs. They have a real withdrawal. And it sometimes has a delay. So it's not always right away. You might get off a med and

feel fine for a week or two. And it might really hit about two months after you get off the med. Certain medications. It can even be more of a sub-acute withdrawal many months later. And so we need to be talking about the withdrawal and we need to be talking about strategies for people to get off of medications more slowly, more sustainably to mitigate that withdrawal. You know, it's like having an off-ram, the same way that we think of physical therapy for somebody who might have broke their hip and is in the hospital, you know, nobody's advocating for, oh, okay, this person broke their hip, we need just to keep them bedridden forever. Well, we know what happens. People's bodies decline. They fall apart.

They get sarcopenia and they, you know, ultimately end up dying if they're completely better ridden and they're set up in those circumstances. That's why we have an off-ramp to physical therapy and building the muscles back up. In that same way, I hear you advocating that for that when it comes to psychiatric interventions because if we don't start to include in almost like, okay, are you part of like a good group or a community or some sort of accountability, you know, even if it was like some sort of derivative of like an AA type, you know, community-centric approach, decentralized, people could be a part of, hey, are you getting your sunshine? Hey, by the way, are you getting

your omega-3s? Do you have the right ratio? We know the literature is out there. How much do you think the emphasis? Okay. So since you brought up controversial topics, I'm going to jump right in. How much of the emphasis of, hey, we can never take people off and physicians, you should be scared shitless, if you're even thinking about broaching that topic and integrating other methodologies, how much of that is being driven by the for-profit side of the pharmaceutical industry? Just your hot take on the situation. Yeah, it's not so hot. So here's my take.

I think that some of it directly and some of it indirectly. Basically, you know, our medical training is extremely influenced by, pharmaceutical industry. And some of it, it's really like a thoughtful delivery of like, here's how we want to influence physicians to think. And some of it's indirect. If you think about it, we as physicians, you know, practicing evidence-based medicine, we always want to do what the standard of care is, what the guidelines encourage us to do, what the data says. But what's the data? That depends on what's being studied. And when most of our studies are being funded by the pharmaceutical industry, like a Pfizer or a GlaxoSmithKline has absolutely zero incentive to

make it apparent to demonstrate that there is a withdrawal from their medications. They don't want that on the record. And then, and so to study it, to demonstrate the problem and to talk about mitigation strategies would be admitting fault. And I think that it doesn't get studied. And also, they want lifelong customers, right? So we don't study how to safely get people off of meds. It doesn't get built into our guidelines or our standard of care. Physicians aren't educated about it, not to mention the fact that it's a pretty high liability problem. I mean, even someone like me, I'm steeped in this practice. I do it all the time every day. When someone comes to me to get off of a psych med, I take a deep breath. It's a messy journey. And I have many, many patients who

become suicidal in that process. And even, and you know, we might think to ourselves in almost a judgmental way, like, well, yeah, that was someone who was depressed and suicidal. And that's why they were on the med in the first place. So getting off of it, that all comes back, almost like that relapse idea. But I've had patients who went on Prozac for, like I think of one patient in particular, he went on Prozac when he was going through a divorce. He had never been depressed in his life. He had certainly never been suicidal. He was going through a stressor. And he was having trouble functioning. He wanted to go on a medication to support him through this divorce. He went on it. He stayed on it for about a year. And then he was like, okay, I'm good. I don't need this medication anymore.

And this was when I was still learning this craft of mitigating withdrawal. He went off it too quickly and he became suicidal. And this was de novo suicidal ideation, right? This was not his illness reemerging. This was the experience of when you pull this sort of psychopharmaceutical rug out from underneath you, and that brain, re-equilibrating, can feel quite a bit of numbness and despair, and it's a pretty dangerous cocktail of reactions that the brain goes through. So what physician wants to take this liability on? You know, you don't want your patient suffering, and you certainly don't want to be the one left holding the bag.

And so I think that for all of these reasons, it's really hard for people to find support for getting off of meds properly. and we have a big problem on our hands because we have millions and millions and millions of people on these meds and some of them want to get off but don't have a good strategy. Yeah, and it's really an education challenge, not just for patients but for physicians as well. You know, we've had on a gentleman from Harvard on the podcast who wrote a book called Sickening, Dr. John Abramson. And one of these quotes from his book, he was saying, you know, most physicians are so well-intentioned,

but they don't understand this one biggest kept secret. And I always keep this quote handy because you never know when it's going to come up and need it in a podcast. So I'll just read off of it if it's okay with you. One of the best kept secrets in all of health care understood by few doctors is that the peer reviewers, medical journal editors and guideline writers who are assumed to be performing due diligence to ensure the accuracy and completeness of the data reported from a company-sponsored studies do not have access to the real data from these trials.

The published reports that the doctors accept is fully vetted, scientific evidence can be more accurately described as unverified data summaries prepared largely by and for the sponsoring drug companies. It's not to say, now this is just me talking, it's not to say that studies are, I mean, they're so valuable. They bring so much to the table. And it's also understand that sometimes when the long-term effects of something like psycho-active drugs, SSRIs and other things are looked at, and we look at the safety and just blankly saying, well, we just assume this is all safe, even though that clinicians like yourself might say, hey, look, it's kind of a balanced conversation. Yes, we need them for our patients, but we also have to understand the withdrawal process or the long-term harm that might come from them.

without having the other holistic strategies. And another physician might say, well, there's no data to support that. Well, maybe some of the studies to begin with are not incentivized to even look in that direction because why would the company want to? What benefit do they have for telling you the harmful challenges that people had when they got off of these things? So it's just another piece of the puzzle that I think it's important for not only people listening to this podcast, but also physicians to also understand. And I have a real B in my bonnet about the expression. There's no data for that. There's no evidence for that because A, evidence of absence is not evidence or absence of evidence is not evidence of absence. And B, we look at the incentives of like what studies are going to be conducted and what are going to show positive findings, what studies are going to be published, what studies are keeping the lights on it, medical journals. And then I think that we also just have to understand what lends itself to a study. And we, the pursuit of evidence-based medicine is really the

suit of truth. Beautiful intention to that. It is corruptible. It's been bought. And I think that when we think that the only valuable way to answer a question is with a large meta-analysis of multiple randomized clinical control trials, we overlook the fact that only certain interventions lend themselves to that kind of study. So it really favors something that hits the brain like a Mack truck. And so then you're going to see a result in six to eight weeks by taking a pill, something you can really standardize. And the sort of interventions that I deal in are not a mack truck to the brain. You don't necessarily have an overwhelming signal after six to eight weeks, but these are safe interventions. There are many of them non-invasive. Most of them are through

an ancestral lens, have a biologic plausibility angle of like this makes sense that this would be helpful to the human body and brain. And I deal in why not. Like if something is safe and affordable and accessible and not too much skin off your back, like why not try? Because this might get you all of this high potential benefit. And we can't have an attitude of why not with invasive interventions, things that can have harm. But with things that have not side effects but side benefits, why not try whether or not the evidence has caught up? can you think of because I'm sure now obviously it's it's why not you are so familiar you're well respected in this space people are asking you to speak we were just on a panel together

at a conference here in Los Angeles which was a lot of fun thank you for that that was great to have you on that panel but when you first got started as a physician in the space who's switching the way that they're practicing I'm sure there was a little part of you that were like is this going to work in the way that I wanted to and like I wonder what it's going to be like, can you think of any early case studies, early patients that you were working with where you were kind of like not sure, even though you know that the harm of some of these interventions is like non-existent to very little. It's just trying it. But you were astonished because it was your first actual patient that got better. Any case studies or things you can share with us?

So many. I mean, that's why I continue to do what I do and why I do feel brazen and making this, taking this really different approach to medicine. There's a case study. I bring her up in my book. I've tried to think about what fake name I give her in my book. Let's call her Carla. And basically, she was a patient of mind and residency, and she was really suffering in a number of different ways. She had severe trauma. She was really physically unwell, very inflamed, malnourished, terrible sleep habits. She was medicated up the wazoo, you know, everything that I'm here to correct. And she was... actually, she was so impactful because she was sort of clear with me that the medications hadn't

been helpful. So she already suspected this was not the path up the mountain for her. And so that it made it possible for me to start thinking creatively and differently. And I was already studying Chinese medicine and acupuncture and nutrition at that point. So I was like, I'm game for this exploration. And the first switchout we made, we changed her sleep habits slightly. She would come to my office carrying like a 2.5 liter Diet Coke. And so we switched that out. I got her in the habit of drinking seltzer instead. And then eventually she was up for cooking for herself, which was a big that helped. But she found that healthy food was too expensive. So we just got her to get frozen vegetables, dried rice, dried beans, and a huge, like olive oil and a huge butter. And so she

started making rice and beans and vegetables for herself. plenty of healthy fats. And like that was the real turnaround for her, was going from eating fast food to eating real food. And she just felt better. And she did this very much on a budget. This was not fancy, bougie, farmer's market, grass-fed, regenerative aquaculture. Like, this was as cheap as it gets. It was cheaper than the fast food that she was getting. And it just took some of her time. But not a lot. We figured out hacks to make this really easy. And she started feeling better. And So that was like, this is like a drug for me, as it were, because basically now I was seeing how someone who was really demoralized by the system, not feeling hopeful in any way, had no reason

to think like anything we were going to do was going to help her. She was just kind of coming to the office and being like, okay, another psychiatrist, let's, you know, see what this does. And instead, we completely changed the inertia of her healing trajectory. And she was just thriving afterward. And so for her, diet changes made an enormous difference. Sleep changes made a difference. And I got the bug of, this is helpful.

This is safer. This is less expensive. This is non-invasive. It makes sense that this works. And there's evidence now, you know, in an anecdotal sense that this works. As you started a shift, how you treated and worked with patients, what were the colleagues and your peers around you saying? Did they approach it with curiosity?

was their combination? Like, how did the whole process, how was it received? Ha, ha, ha, ha. Curiosity and openness. No, Drew, no. I think that, I don't know. I mean, throughout my training, talking about diet, lifestyle, yoga, breathwork. Like, I mean, I think psychiatry in particular has been on a lifelong journey of trying

to legitimize itself. as a science and trying to root itself in evidence and make it very objective and measurable and chemical and, you know, they call it even like a biologic approach to psychiatry as opposed to a for shame, the Freudian psychodynamic approach. So we're really trying to root ourselves in the evidence. The tricky thing is that the brain is like this funky organ where, yes, it's a pile of chemicals and it's also a pile of like unmet psychospiritual needs. And so I think that it doesn't perfectly lend itself to that model. And so, no, I've certainly encountered resistance around every corner. And I get a lot of the like, I like you, but everything you're saying sounds like,

yes. And so I think that, I don't know, I think it's been really important for me to, I think this actually has traces in just going through life as a woman and going through my own journey of self-loathing misogyny and silencing my own intuition and being like, okay, I want to, I'm observing this world and I want to be accepted in the boys club. I want to be thought of as smart. And therefore, I need to be seen as rational and objective and not sensitive and not emotional. And so I knew really quick how to perform that and how to be accepted, how to talk that language and how to be accepted in those clubs. And I did well with that. And there was a moment in my early 30s when I kind of had a coming to,

to do this moment where I was like, wait a second, none of that has been true for me. And I don't need to be ashamed of having connection to intuition. This is not something to hide. This is actually a compass to leverage. And I just stopped apologizing for being a woman, basically, and stopped trying to fit into the boys' club and be perfectly objective and emotionally even. I embraced being a sensitive, snowflake, witchy, intuitive person. And it's, you know, I would have made me just like to in high school when I was trying so desperately to be seen as objective and reasonable like it would drive me nuts how I present these days but this is much closer to my truth and I think that we as a world in the yin yang sense were obsessed with the yong

the masculine the action the productivity that's what we value and we devalue the yin that feminine aspect receptivity intuition non-doing rest and not only am I here to embrace my own yin but I think like our world is really starving and being so imbalanced, in balance towards the young. We need to start valuing yin. We need to value this more feminine aspect that we all contain. And so I'm actually here as somewhat of a one-woman army being like, let's bring intuition and witchcraft back to medicine.

I love it. And I also think in many ways, you can also have women who are stuck in the system, not to make this about men or women, but just to add on top of what you're saying, there can be women that are stuck in the system that are part of that boys, club too. I mean, there's many pioneers like yourself in functional medicine that have been on this podcast that said they've gotten ridiculed just from the system as a whole. And that boy clubs,

that boys club, even if they're a guy, is just symbolic of just like the system that's there. So sometimes the system has so much inertia that it's just scared of anything new to come into it. And it requires game changers like yourself to say, you know, we need to shake it up because they see that so many people are suffering. You know, on that topic of people suffering, Let's dip back into the tools in the toolbox. You mentioned breathwork. How do you decide which people you work with or who's a good fit with for an intervention of breathwork?

And what does that typically look like? What kind of tools or resources or apps do you share with your patients to get it? So who's a good fit for it? And how do you recommend them doing it? Oh, I'm very, very, very diligent and prudent about who I quarterback towards psychedelic medicines. Breath work, all comers. I mean, I think that there's a form of breathwork practice that's appropriate for all of us, and it's free. And you could do it just about anywhere except we're driving and operating heavy machinery, and it tips our nervous system from a stress

response to a relaxation response. So this is just a good drug. And I dole it out pretty liberally. I really like breathwork. I think that people are often pushing back at the functional medicine industry and saying like, well, this is expensive and this is inaccessible and it's built on a foundation of privilege and some of it, absolutely. But so much of the good stuff is free. Like sleep, movement, sunshine, breathwork, free, free, free, cooking your own dried rice and beans and frozen vegetables as opposed to fast food, a savings. Avoiding caffeine and rosé, a savings.

So I think that when it comes to breathwork, I like it because we are so chronically stressed and we also are such deranged breathers as we learned from the amazing James Nestor on our panel. And I think that part of the reason I like breathwork is that our brain is a little bit gullible. And it turns out that if you breathe the way a genuinely relaxed person might breathe, deep, slow, diaphragmatic breaths, the exhale a little bit longer than the inhale, like the way we would breathe if we were a baby without a care in the world or if we were on a hammock and we had just had a 20-minute shavasana at the end of an hour and a half massage and we were like genuinely relaxed this is how we would breathe and we don't that doesn't come cheap these days we don't feel relaxed like that

but we can breathe in that way and it's bi-directional communication between the brain and the diaphragm so we can send the signal up to our brain by jove i can't believe i'm saying this but the organism is relaxed and the brain believes it. And so a whole neurohormonal cascade of relaxation ensues. So we can leverage that bi-directional communication. I really, that's a whole avenue of how I approach mental health that I think is so empowering is that there's all this bi-directional communication between the brain and the body. And we as a culture right now kind of get it that when we're stressed, when we're anxious, it's impacting the brain. It's giving us a nervous stomach. It's giving us diarrhea before a test. It's making our breath more shallow.

and more rapid. It's making our jaw tense, and all of that is true, but we're overlooking the other direction of communication. And in many ways, intervening at the level of the body is the easier entry point. So by relaxing our jaw, by holding pigeon pose to relax our hips, which is interconnected with the jaw, by breathing in a relaxed way, like doing a four, seven, eight breath, by healing the gut, we can send a really different signal back up to the brain that says we're relaxed. Let's be relaxed. Any favorite resources that are out there that you want to drive our audience to or teachers that are in the space or anything of like just like a good introductory into stepping into breath work? The breathing exercise I typically teach my patients is the

478 breath. I think it's an Andy Weil creation originally, but I'm not really sure about that, but just to inhale to the count of four, hold to the kind of seven, exhale to the count of eight. And I do think James Nestor's book, Breath, is revolutionary, and it's basically helping us understand we need to be breathing through our nose. And we're not, for so many reasons, multi-generational soft diet that's impacting the structure of our jaw and habit. And so you want to create new habits that help you breathe through your nose for better help. What other tools in the toolbox do we want to share right now with my audience? You know, we talked a little bit about blood sugar management. We talked about, you know, how to avoid social isolation.

You just talked about breath work. Any other couple tools that you want to tease out and kind of give a little bit of energy to in this conversation? Yeah. I mean, I think a quickie is don't bring your phone into the bedroom at night. Like commit to this, set up your charger somewhere else in your home so that, you know, an hour or so before bed, you're kissing your phone good night. Like, phone, I love you, I'm going to miss you. And you charge it and you set it aside. and you go into a phone-free sanctuary of your bedroom.

And this is impactful in so many different ways. Part of it is the blue spectrum light that our phone screens emanate, that suppress our melatonin and disrupt our circadian rhythm. Part of it is that social media is ingeniously designed to never cue us to stop. There's no natural stopping point. No one has ever said, oh, look, I got to the end of TikTok, let me put my phone to the side and go to bed at this wholesome hour. So we scroll endlessly.

And the algorithm favors controversy, fear, things that don't make us feel safe. We feel surrounded by danger from social media apps. And so that's no way to surrender into sleep. So just by setting up our phone somewhere else, we're protecting our sleep along a number of different dimensions. And that is going to improve every mental health issue under the sun. That's one. I do think blue blocking glasses are kind of a must. I think that we all just need to be putting a lot of sunset.

Can I share a little anecdote on my side? Of course. Okay. So, you know, it's often that couples have, right? Anybody who's in a relationship right now can probably relate to this, they have like different sleeping patterns, right? You have a little bit of the polarity and people sleep in a little bit of different way. I, as soon as I like lay down, within about five minutes, I can, I fall asleep, right?

My wife hates that. And she's like, do not go to bed yet. I'm not ready to go to sleep because she wants to wind down. She needs to wind down a little bit. And she likes to do that with me. So we have basically bartered and come up with this routine. And that routine is that she likes to watch something. And that kind of helps her, you know, fall asleep or read something or like engage a little bit lightly with something.

Not too stimulating, not the fear-based algorithm. So what I do throughout the week is I actually, I don't really use Facebook, but I've found there's a lot of really interesting like longer format like five, five minutes, 10 minute little almost documentary style things on Facebook under the watch section. And I'll save some of those like gentle videos. It'll be things like how Japanese sushi makers make the best like sushi rice, right? Like I'll find something like that on Facebook and I'll like save it. and I have a watch, I have like a playlist and I call it, yeah, yeah, because it's my wife's nickname. And at night, our agreement is we turn off the overhead lights, we kind of put the red lamp on

or sometimes put the blue light blocker glasses on. And she puts her phone away, right? She puts her phone away because she knows she gets into her phone and immediately is like doing the whole work thing or emails and very stimulating things. So she puts her phone away on the other side of the room. and I have my phone. I said, all, babe,

we have 30 minutes. We have like 20 minutes, right, of wind down time. That's like our negotiated thing. And I'll keep and I'll play a couple of those things again with like the orange screen or blue light blocking glasses on and that it helps us like wind down. And it's like our way of having negotiated to be able to be watching something engaging that helps her relax,

but not too stimulating that gets us both worked up and we can't fall asleep. So do I have the doctor's approval on that? Any other suggestions or changes you need me and my wife to make in our protocol? You basically have my full blessing. I do want you to be both wearing blue blocking glasses religiously for this practice and then otherwise full speed ahead. And yeah, and like process with each other. I mean, I do think that I share that with Yaya.

Like I want to process my day. My husband gets the full play-by-play download, much to his chagrin often. But that is how I metabolize what I've gone through in the day. Yeah, you have my support. I would say like three other like quick tips that come to mind. Your readers don't need this message any more than I already have, but I'd be remiss if I didn't mention magnesium glycinate, which like helps with anxiety and insomnia and digestive regularity and cardiovascular health and headaches and menstrual cramps and migraines and longevity.

Just do the thing. Just quick question for you is what's your dosage and what time do you take it typically for yourself? Me, I take like one 120 milligram capsule sometimes too at bedtime and sometimes I do an up some salt bath instead. For my patients, I encourage them to kind of play around with the juice a little bit. People can take up to like 400, 600, even 800 for some people, but you know you're taking too much if you're getting loose stool. So then you ease back off.

It's not like you have to be super consistent. It's just a helpful thing to take when you can manage to remember to take it. And then I like a shaking practice. This is a weird one, but I like interventions that are free and non-invasive and effective and have an evolutionary ancestral plausibility for why they work. And when you look at animals in the animal kingdom, after an acute life or death stressor, a lot of them have a shaking practice. It seems to be how they complete the stress cycle, meaning they discharge the excess of adrenaline until their nervous system. Now the threat has passed. It is once again safe to be in my body.

And we as socialized human creatures, no shortage of stressors in our lives, but most of us don't shake every time we get a stressful email. So you want some way of completing the stress cycle. And that can be exercise, dance, singing, chanting, journaling, talking, crying, which we're due for a cultural rebranding around. It's not a sign of weakness. It's not something to make smaller or apologize for something to dive into and let it be big and complete. It's free therapy. What I do, in addition to crying, is I shake to shamanic drum music, which seems to sync up the brain with theta wave patterns, and it kind of excavates all the different traumas that get stuck in my connective tissue and just control alt-olates my nervous system. So it's nice.

I just put on shamanic drum music on Spotify. In a practical way, what does that look like? So you have a playlist on Spotify. Maybe we could link to it. We sure could. I am a one-trick pony, and I have used the same exact track of music. for like 10 years now, but it's a drum, it's AMA extended mix by James Asher. And I just put that on.

And if I have 90 seconds, I shake for 90 seconds. If I have 10 minutes, I shake for 10 minutes. But I'll just close my eyes, let my body be really floppy and move however my body feels like moving, which I think itself is somewhat reparative because we're so used to contorting our bodies into movements that we think look cool or look appropriate. And our poor body never gets to be like, well, here's what I need to do. So I just shake and move however my body feels like moving. I love that.

That's beautiful. And on a practical level, you know, you have kids. You have a husband. It sounds like you have a full house on a regular basis of people that are there. On a very practical level is, have you just been doing this so long that you don't even care if you do it in front of your husband? He doesn't care. He's like, you're just doing your thing.

Do you find that it's important for you to kind of be in a private room? Just thinking that through for our audience who. might, you know, be asking themselves that question. Yeah. I mean, if you only feel comfortable doing it in private, you could totally start there. You can do it. You could draw the shades and make sure no one sees you. You can rope your family into it. Do you ever rope your family into it? I rope massive quantities of people into this. I rope corporate wellness presentation groups into this and entire birthday parties. Yeah, no, I wrote people in, but I'm maybe lacking the shame muscle around this. But I think that people always feel good afterward. And you actually, if you're,

if you're following the rules, everyone has their eyes closed. So as long as no one's peaking, there's nothing even to be embarrassed about. Yeah. And if you're cheating, well, then you're going to go to hell. So that's on you. Yeah. Yeah. So enjoy that peak of all of us looking ridiculous. Now how do you face yourself in the mirror? One other quick chip is when it comes to mental health, what I'm seeing so much these days is the ways that we are strung out on the media and a kind of news information overload. And it's for anybody listening right now who resonates with that, I want to just open up the conversation around the fact

that we are living in the attention economy. Our attention is the commodity that really smart companies are competing for. And they've done their homework. They know their neuroscience and their behavioral psychology. They know that if they prey on our fear response or instill uncertainty or doubt or controversy, we will rubber neck. We will hand over an increasingly large share

of our attention. They get more clicks and more revenue. They're the big winners, but our mental health is the collateral damage. And so we want to navigate the information landscape with our eyes wide open, really deciding consciously who gets to tell us what and in what way and how often. And we don't just want to hand our attention over thoughtlessly. And I love the words of this woman named Brittany Packnett Cunningham who says we need rested warriors. And I think that's such an important insight here because sometimes when something is really messed up in the world, we think that by endlessly scrolling, we are staying informed, we're staying a part of the conversation, and we almost believe that that's how we help. And to a certain extent, maybe, yes,

but I think that what really happens is we get so strung out that we're not rested, we're not fresh, we're not creative. We're not able to show up in our best capacity to be of service. So we really want to stay informed, but then we want to protect our energy so that we can be of service in a more effective way. I think that's such a powerful reminder because in addition to that being with the news, that's also that with just all information, even well-intentioned information in the world of wellness.

And I'm part of that ecosystem. You're part of that ecosystem. We have to know and check in every so often when doing less is actually. the thing that we need to make progress in our lives. And sometimes doing less means listening to less podcast. And yes, that gives my audience permission too to listen less to me. You have to know when the right time for you to put the foot on the break is so that you can give attention to maybe just a couple simple habits that you're working on.

Could be this breathing exercise you shared. Could it be this shaking exercise you shared. And you're just like you're just focused on that for a little bit. and you're not inundating your body with messaging, which even again, if it's well-intentioned, sometimes the subject, subtext is you're not enough. You're not enough. You're not doing enough. You don't have enough.

And only if you could do the right thing, then you'd have it all figured out, which that's not true. So I think that's a good reminder for all things, media, but also a lot of the well-intentioned people that we surround ourselves with who are trying to help us, but we have to know when it's too much for us and we're going to take a little bit of a break. It's absolutely right. And the wellness industrial complex is at fault here as well, right? And we are in trying to help sometimes inadvertently, sometimes on purpose, instilling a message of you're broken, you need me, you need fixing, not enough. And often the right thing to do

in response to that is unsubscribe. You don't necessarily need any kind of fancy wellness practices. We need to get back to the fundamentals, sleep, movement, nourishment, doing less, saying no, stress management, being time in nature, time with people that we love. And those are the real strategies that actually support our well-being. And I think that I have so much sympathy for why it's so hard for us to be with ourselves and to say no and slow down and do less. And I look even at what happens with my six-year-old. And like when she has a meltdown, there's this temptation to hand her an iPad, to get her a toy, to give her candy, to basically numb her out or distract her or hop her up on some drug so that meltdown over, she's happy,

the household can be restored to a state of peace. But I think when we do this with our kids and we also end up doing this with ourselves, we train ourselves to think, I can't be with my big feelings. I cannot tolerate these big feelings. The people around me can't tolerate these big feelings. And any time I'm having big feelings, let me find a just thing. distraction or a drug and or something that will numb me out. And so I think what we need to, we really need to recalibrate like the same way that if we're

eating a lot of processed foods with their drug like Franken food qualities, like those flavor crystals that you eat one Dorito and then it's like, oh, I'll just have one Dorito. No, it's not a thing. You have many Doritos because it changes your palate. You suddenly want to re-engest it. I think the same thing happens with how we respond to. to the various moods of the human experience. And so our palettes, our emotional palettes right now are calibrated to always finding distraction,

never being still with ourselves. We just need to recalibrate. We need to stop the Doritos for a little while. We need to stop the iPad and the social media and the numbing out with food or sex or alcohol or whatever is our drug of choice. And we need to slow down and be with ourselves and ride those waves. It's not necessarily comfortable, but it's an attunement to ourselves. It's a way of becoming intimately acquainted with ourselves and our needs and our truth.

And I think we need to get back to that these days. And I think it would actually help our cause in so many ways and the ways that we suffer. A couple more topics I want to explore with you as we line down this interview. The first one is, what do you want our audience to know about the relationship between trauma and the right process of investigating, you know, whether it's build up of little T traumas or big T traumas in our life? life, what do you want our audience to know about trauma and anxiety and the relationship between the two of those? And then we'll get into the second topic that we'll go in. But let's start off with trauma. What's the relationship with trauma and anxiety? And how do we start to unpack or even

investigate that area of life if we've not really gone into it before? Yeah. So, I mean, I don't even know if we've fully framed the true anxiety, false anxiety premise just yet. You could frame it. Yeah, this would be a great, great time to do that. And so, the way I frame it in my book is to think about anxiety, not according to what I was trained to think like, oh, it's generalized anxiety disorder or panic disorder, all of this. Like, that's designed to standardize our diagnoses for research studies and steer management, but it was never steering management in a meaningful way in my practice. And what I observed was a much more meaningful way of categorizing anxiety was to think of it as false anxiety and true anxiety, where false anxiety

is physical-based anxiety and it's avoidable anxiety. This anxiety caused by these states of physiological imbalance. And once we address that at the root, we can really eliminate all of that unnecessary suffering. And then true anxiety is not something to pathologize. It's not something that we can decaf coffee or gluten-free our way out of. It's our inner compass here to force us to slow down and listen and heed a message. It's a communication from some inner truth. And usually it has a call to action baked into it, like some course correction that's needed in our personal lives or our community or the world at large. And I think trauma is really interesting in that it really exists at the interface of these two kinds of anxieties. And on the one hand, it's very much true

anxiety. It is it is what makes us up. It's our epigenetics. It's our intergenerational trauma. It's our truth. It's a story that we need to tell. It shapes who we are. And we're here to show up and make sure that we are making other people feel less alone and helping open up the conversation. I think trauma is very much a part of our truth. And it needs to be honored. It needs to be processed and listened to. But I think there is a false anxiety component to trauma, which feels just a nudge to invalidating. But it's false in the sense that what trauma does is it works on a level of the limbic system.

And it makes us hypervigilant in a state of hyperarousal, basically perceiving threat. And that's an adaptive response to trauma when we are living in an unsafe environment. If your environment is chaotic or unsafe, it's adaptive to constantly perceive threat and to sort of bias our perception toward like this, I can't trust this situation. But if you're lucky enough to have emerged from an unsafe situation and to get yourself into a safe situation, then suddenly that hyperarousal and hypervigilance becomes a maladaptive response. And it just makes it hard to relax into and enjoy your life and to feel trust and relationships and all of this. So it becomes a maladaptive trait. And it's happening at the level of the Olympic system. It's almost like the foot is stuck on the gas pedal in that hyper-arousal aspect of our

limbic system. So there's a false quality to that. It's something to be repaired. And we think that we should go to therapy and talk about our traumas. But what the data shows is that in many ways that's not effective and even more concerning is that sometimes it's re-traumatizing. So what we want to do instead is go to a trauma-focused therapy. something like eye movement desensitization reprogramming EMDR or somatic experiencing therapy.

There's kind of a DIY program called DNRS or dynamic neural retraining system. So there's all these different trauma-focused therapies that are not so talky-talky verbal. They're operating at the level of the limbic system. And that's much more effective and I think safer. And so for anybody working through trauma, just my utmost sympathy, and I really encourage people to find a good container and to start slowly metabolizing what they're holding. And I think Bessel Randall Cook's work, the body keeps the score, is absolutely a must read

and a really important understanding of the fact that this is not held so much in our memories as in our bodies, in our connective tissue. And that's the level of which we want to intervene and heal. Beautiful. Yeah, I love that book. It's a great resource. If anybody hasn't read it, we'll link to it in the show notes. so you can pick it up. All right. I saved one of the best topics for last, and that is something

you mentioned earlier, psychedelics. And we've done episodes on this topic. You write about it. You've talked a lot about it on social media as well, too. It's very interesting from your perspective as a psychiatrist and MD. How do you help people navigate the world? What's important for them to know if they're thinking about digging into this topic a little bit further because there is so much interest that's there. So give us a couple top line things that are important for people to know about the topic of psychedelics. Yeah, I had a feeling that's where you were taking me next. So, I mean, it is a promising new line. And of course, anytime we always just make things so gross in the West, you know, we're like, oh, psychedelics, it's the silver bullet, we'll solve everything. And then, of

course, there's the inevitable backlash. They're like, oh, there's risks. It's like, there were always risks. The caveats are important here. I mean, nothing that we're saying is medical advice, but with this, I don't say a caveat as a medical, legal, you know, cover yourself thing. I say it because I don't want people to get the wrong idea about these medicines. They're brains for which this is such therapeutic medicine, and there are brains for which it's truly harmful. And so you do want to navigate this with care and recognize whether or not it's truly indicated for you. But I think that when it is indicated, in my practice, I wait. I really think very judiciously about when is the right time to raise the conversation about it.

And then I think of myself as like a quarterback really, I mean, if I even understand football at all. But I'm really pointing somebody toward the appropriate setting for them. And for one person that might be doing like a very above board, you know, off label, like a legal approach, you're going to a ketamine clinic. and for somebody else, it might mean that they are taking a trip to South America and doing an ayahuasca in a traditional setting. And somebody else might actually work with an underground psilocybin practitioner or be in a couple's therapy with MDMA. And it's all just, it depends on the person and it depends on what I think will benefit them

most. But the reason I like psychedelics for mental health, and I do think it's a promising new line of treatment, part of it are all of these. more physical mechanisms that make sense to us already. Like it's active on our serotonin receptors, our 5HT2A receptors. So it seems to increase that kind of serotonergic activity, and that seems to account for some of the antidepressant effect. It's anti-inflammatory, many of them.

They promote the secretion of BDNF or brain-derived neurotrophic factor. So we're more neuroplastic, and it promotes neurogenesis, which the translation into English is we can grow and change. and adapt. If we're stuck in an entrenched pattern, we can shake the snow globe and the snow can fall in a slightly different pattern afterward. The way it quiets the default mode network is really intriguing because it's almost like our default mode network is sort of geographically where we hang out when we're not focused on a task and it's kind of where we future trip or dwell on the past. And it's also where we ruminate and where we think of ourselves as this

narrow definition of our self is separate from others. So quieting that even for a few hours gives us this taste of what it could feel like to expand that narrow definition of the self, to feel connected to people in our community or perhaps all sentient beings even. And to just, I think that that's medicine to our hyper-polarization and our division and our resentments and our social isolation. but the part about psychedelics that I find to be most exciting is what's called the mystical experience hypothesis. And it basically shows that the extent to which a psychedelic experience is a peak spiritual experience in your life

correlates with the efficacy and the enduring effect of whether or not this is an effective antidepressant or anti-anxiety agent for you. And that's interesting because that sure is nothing like our current treatments. We're not looking at Lexapro and being like, well, the extent to which Lexapro gave you a peak spiritual experience is going to correlate with how effective of the antidepressant is. No, this is doing something really different. And my colleague and friend Will Sue has a really great way of putting it. Let me think if I can paraphrase it well enough. He says, psychedelics are not just tools for, they're not just agents for healing trauma. They are tools for making spirituality palatable.

for our starving Western world. And I think that's actually at the heart of true anxiety, where part of our true anxiety is the vulnerability of being a human and having attachments, people that we love, and not wanting to lose what we love and not wanting to stop living. And that's, you know, very valid fear, this immense vulnerability of what it means to exist.

But there's another truth baked into our true anxiety, which is that I think we, feel this responsibility to hold on and to be in control and to be hypervisual and to anticipate all potential negative consequences because the idea of a worst case scenario in our lives feels like you know game over and it just feels so absolute and so negative and I think sometimes what psychedelist can do is just peel back the curtain ever so slightly on the possibility that perhaps what's occurring here is something vastly beyond our comprehension. And I find that that actually really takes the pressure off,

and it makes loss feel a little bit less absolute. It makes me open to the possibility that people that I've lost perhaps continue to exist in some form, that there is some spiritual encouragement to play around at the edges of feelings like trust and surrender. And I don't mean this as a spiritual bypass of everything happens for a reason. Fuck that, right? This world is full of immense tragedy, suffering.

It's not okay. But to have a way of making meaning of the unfolding events of our lives can be really grounding, really calming, and I think is a path out of a lot of unnecessary anxiety. Beautifully stated. Thank you for sharing that. 10, 20 years from now, do you see, you know, your future self in our current world, political influences, everything, FDA, all that other stuff. Do you see things opening up in a space where you're able to write a prescription for a patient going down that journey in some shape or form, maybe a clinic, et cetera, whatever it be when it comes to psychedelics? I think 10, 20 years from now, we will see

MDMA become FDA-approved. I'm most excited about the implications of that in couples therapy because this empathogen that can take down our defenses and help us examine our role in the chaos of our relationships. Like, I think we're going to save a lot of marriages. I think that psilocybin, I do think, will become FDA approved for depression initially. And I'm looking forward to that. I know a lot of my patients think, okay, great, I will sub out microdosing psilocybin for my lexopro.

And I actually don't think that's where we're headed. I think that what I've observed seems to be more effective in my practice is not subbing out microdosing, but actually the occasional macrodose of a psilocybin ser. I think it, you know, to make it spiritual and to make it a mystical experience so that we kind of keep getting that, yes, dose of BDNF and 5HT2A receptor activity, but also that dose of perspective and awe. And I am worried that practices like, you know, traditions around ayahuasca will sort of become bottlerized in the West and the way we just sort of take everything and exploit it and make it gross. I'm worried about that. So I really hope we can preserve the sort of reverence and making sure that we just show up to these medicines, keeping them sacred and giving them the respect that they deserve.

I don't know. I'm not so hopeful of that, but I do hope we have an eye towards that. And, you know, I think one layer that I'll add to that is that, like, you know, I'm South Asian, I'm Indian background, right? I know your husband's also Indian too. There's a lot of people who are in America who are in. Indian who feel like, and not the majority, by the way, they feel like, oh, yoga has become bastardized.

It's become this. It's this performance thing. And meanwhile, every single one of my friends and cousins that are in India and largely most of my family that is not too woke, it's like, oh my gosh, how amazing is it that, like, America has sort of like made yoga fun and popular because I'll tell you what, growing up, I used to go to India all the time. I never once saw people doing yoga. I never once saw any of my family members doing yoga.

It's only now that it's popular here that people have gotten excited over there. So I want to make sure that within that balance, there's also understanding that, you know what? Sometimes if things are marketed and they get excited and there's hoopla around them, well, people get excited about that. Now, we have to be sacred in it, right? but it's not all bad. So I just want to toss that in from my personal experience with yoga.

Drew, you have officially changed my mind right here and right now. I think you're absolutely right. And the fact of the matter is, like, who cares? It's probably just like a cool, too cool, lightest attitude to have about it. In a sense, like, you know, I'm a white girl that does yoga

and it changed my life. And outclassed every medication that any primary hair doctor threw at my PCOS and my depression. Yoga was the thing. and am I part of the gentrification and the American botherization of it completely? And yet I think it's done good things for me and then hopefully I can turn around and help it do good things for others. And I think that maybe the same will be true of all the different psychedelic medicines.

So I just hope we approach more things in general with reference and keep them sacred. But maybe this is just what will help the U.S. and the starving Western world have a little bit more reverence in general. So yeah, I'm in favor. Yeah, yeah. I think there's people suffering and any time we can help people with suffering, even if that means a little bit of marketing in the mix too, I'm okay with tackling human suffering that way. So on that note, just the fact that you've put together this incredible book and upped your social media content and going on podcast and like really put yourself out there an incredible way. By the way, you can find the link to it in the show notes, The Anatomy of Anxiety. Dr. Ellen Vorah, you can find it there. I just want to give you credit because I will say that it used to be seen prior to social media that practice as a doctor was just one-to-one patient care, maybe occasionally some groups or a little bit of training.

But now, many physicians that are out there, people like yourself, are really stepping to the fact that the world is suffering. If I don't turn the spotlight on me temporarily just to get this message out there, people are not going to get better. And by the way, people learn from people. So you sharing your story, talking about your experiences, going through everything that you've gone through. That is what people connect to. And you did that on our podcast today.

And I just want to bow down to you for having the courage. I can't imagine at times it was easy, especially with ridicule and your industry and this and all different things. But you did it. And the world is better for it. So thank you so much for taking that leap. And thank you for joining us on the podcast today. Oh, Drew. And I mean, just to like circle back around.

When I finally let go of my internalized self-loathing misogyny and started to listen to my intuition, it became very, very clear that this was the path that was supposed to take. So I feel imbued with purpose. I know I'm right where I need to be on my path, showing up, learning, growing, fumbling, and sharing this message. And yeah, I mean, it's clear that we need a different conversation around mental health. The current state of mental health is not adequately meeting people's needs. So I'm here to open up a new, nuanced conversation. I'm open to learning and growing, but it's an honor to be here talking to you about this.

Pleasure. Well, we have all the links to follow you on your journey on social media, the link to the book, which please, I would recommend everyone grabbing today. Anywhere else that you want to send our audience, any fun things that you have coming up that you want to put attention on? If you want a good laugh, I'm over there on Instagram at Ellen Vora MD, a boomer trying to do reels. And then, no, my life's work.

Are you on the TikTok train yet? I'm like a little bit on. the TikTok. Yeah. Let's go. The world needs you. TikTok is where it's out right now. It's true. I mean, that one is even more of a good laugh if you want to see a boomer struggling. So I'm over there, same handle at Ellen Forra MD. But my life's work is distilled into about 250 pages in my book, The Anatomy of Anxiety. So if anyone resonates with this message, I really hope it can be helpful. Dr. Ellen Vora, thank you again for being on the podcast. Super appreciate you. Thanks, Drew. I appreciate you.