The Liz Moody Podcast - Ask The Doctor: Anxiety Edition—Everything You Need To Know About Treating Anxiety Naturally with Ellen Vora, MD

Episode Date: March 4, 2020

This is the second edition of Ask the Doctor, where I ask functional medicine doctors a ton of questions in a single episode so you can reap the benefits of all of their knowledge (check out the first episode, featuring Dr. Will Cole talking about inflammation, hormone balance, birth control, and more, here). This episode is all about anxiety, and features one of my favorite people in the wellness world, Dr. Ellen Vora. Ellen is a holistic psychiatrist who did her undergrad at Yale, then went to medical school at Columbia. Now, she has a private practice, is regularly featured on sites like goop and mindbodygreen, and she speaks around the country about natural ways of dealing with mental health. She’s also a yoga instructor and a licensed acupuncturist. I wanted to create an episode that was THE go-to episode for anyone suffering from anxiety, whether it’s chronic or more situational, or even if you want to help with someone you love who’s dealing with anxiety. This episode is SO comprehensive—I tried to ask Ellen literally any question I’ve ever had about anxiety, and I asked all of you on Insta for your questions too. We talk about: The top 3 low-hanging fruits for anxiety The one supplement Ellen recommends to everyone How to tell if hormone imbalances are at the root of your anxiety — and exactly what to o if they are How to treat anxiety or reduce stress when you’re living paycheck-to-paycheck How to actually find and build community and friendships How blood sugar massively impacts your anxiety—and the hack and definitive solution to fix it The ideal diet for someone with anxiety, including what a day on a plate actually looks like How caffeine impacts anxiety, and whether coffee can fit into an anti anxiety lifestyle How to taper off medication (and how to tell if you should) How alcohol impacts anxiety What to do about social anxiety Why you get anxiety the morning after drinking How to improve sleep but not let the idea of not sleeping making your anxiety worse How to stop spiraling when you feel like you’re hitting that point of no return with anxiety The one neurotransmitter that’s the key to alleviating anxiety How exercise impacts anxiety, and what types of exercise are best for anxiety How to help your partner when they have anxiety and how to tell your partner how to help you when you have anxiety Coronavirus, climate change and how to deal with REAL external things that cause anxiety You can find out more about Ellen at ellenvora.com. We’d both of course love to hear your thoughts and reactions to this episode, so please tag her (@ellenvoramd) and me (@lizmoody) so we can continue the conversation over there. A great kichadi recipe: https://www.mynewroots.org/site/2018/01/kichadi-realistic-reset/ Enjoy! PS: Healthier Together is officially a number one best-seller! You can get your copy on Amazon or at lizmoody.com/cookbook. Please keep sending me your creations on Instagram—they make me so happy! Healthier Together cover art by Zack. Healthier Together music by Alex Ruimy. Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello friends and welcome back to the Healthier Together podcast. I am your host, Liz Moody, and I am a writer living in Brooklyn. And I am so excited about today's episode, which is my second edition of Ask the Doctor. I started this series because I have been a journalist for years and I'm lucky enough because of that to get to have access to all of these amazing functional doctors. I use them as resources for stories and I can ask them all of my health questions too. But I know that that's not the case for everyone and that these brilliant people can be really hard to find and kind of expensive and inaccessible for a lot of people. So to remedy that,

once every few months, I have them on the podcast and I ask them a ton of questions and I pack in as much information as possible so that you can benefit from all of their immense wisdom. And the first episode, which was already recorded, it came out, I think, in like November, and it's more of a general health edition. It's with Dr. Will Cole, who is an incredible functional doctor. It has like stuff about inflammation and gut health and hormones. So definitely check that out if you like this format. But this episode is a little bit nearer and dear to my heart. It is my anxiety edition. And I am so excited to share that because many of you, you might know if you've been listening to this podcast for a while, that anxiety is sort of my health issue. It's how I got into the

wellness world. I had really extreme agoraphobia for a while and I couldn't leave my house without having panic attacks. So all of the information in this episode was very helpful to me and really interesting for me to hear. And then also I'm excited to share it because it is with one of my very favorite people in the wellness world who is Dr. Ellen Vora. Ellen and I met years ago through Mind Body Green and since then she has become one of my favorite people to talk about literally anything with. We talk about relationship stuff. We've talked about yoni eggs and living on a commun and food and love and life and I don't know. She's just so wise and she is so brilliant. And she also happens to be one of the best holistic psychiatrists in the country. She did her

undergraduate at Yale and then she went to med school at Columbia. And now she's regularly featured on sites like Goop and Mind Body Green and she speaks around the country about natural ways of dealing with mental health. She's also a yoga instructor and a licensed acupuncturist. But I love personally that she has this very solid Western medicine base, like she can prescribe medicine if she wants, and she understands what's happening physiologically, and she knows how to read labs and all of that. Because I think that if you're going to differ from the norm

and you're going to offer radical new solutions, you need to really deeply understand what it is that you're differing from. And Ellen absolutely, absolutely does. So I wanted to create an episode that was the go-to episode for anyone suffering from anxiety, whether it's chronic or more situational, or even if you just want to help somebody that you love who's dealing with anxiety, I wanted this to be the go-to episode for all of that. It is so comprehensive. It is long. I wanted it to be long. I wanted it to literally answer every single question. I tried to

ask Ellen every question that I have ever had about my anxiety or other people's anxiety. And then I also asked all of you on Insta for your questions too. So we get into everything. We talk about the first that anyone with anxiety should do. We talk about how to taper off medication and how you know if you need medication for anxiety. We talk about the top three low-hanging fruits for anxiety, including the one supplement that Ellen recommends to everyone. How to tell if hormone imbalances are at the root of your anxiety and exactly what to do

if they are, how to treat anxiety or reduce stress when you're actually like living from paycheck to paycheck and you don't have extra money or time in your life. How to find and build community and relationships. we talk a lot about how important community is for assuaging anxiety and for mental health generally. But I was like, Ellen, it's not like as easy as snapping your fingers and being like, I want some friends. So she had great advice about that that I actually found really, really useful. We talk about blood sugar. Blood sugar is so important.

It massively impacts anxiety. So she has a hack for fixing blood sugar issues. And then she has what she calls a definitive solution to fix it. We also talk about the ideal diet for anybody with anxiety, including what a day on a day on a plate actually looks like from the second you wake up to when you go to sleep. Talk about how caffeine impacts anxiety, whether coffee can fit into an anti-anxiety lifestyle, how alcohol impacts anxiety, what to do about social anxiety, why you get anxiety the morning after you drink a lot, how to improve sleep, but not let the idea of not sleeping make

your anxiety worse, which has definitely happened to me. Like trying to sort of optimize sleep and that whole movement that's happening right now. And then you're like, don't sleep out. as well because you're trying to optimize it. So we talk about that. And then I got a lot of questions about how to stop spiraling when you actually feel like you're, I don't know, like hitting that point of no return. And you're like, oh, my God, I'm tipping off into a panic attack.

And she has really good advice for that. We talk about the one neurotransmitter that's key to alleviating anxiety, how exercise impacts anxiety, what types of exercise are best for anxiety. And then there's a lot of like relationship stuff, how to help your partner when they have anxiety or how to help your partner deal with you when you have anxiety. I even, I've had anxiety for years and years and years and years. And I still struggle with how to communicate to Zach what I need in all of that and how to help him help me. So we talk about that too. And I also get her take on things. This is says a lot about me. But I've been like, I worry about stuff in the news,

like Ebola and coronavirus and climate change. And so I got Ellen's take about how to deal with the fact that Sometimes the world really is scary. It's not just like your head or hormonal imbalances or things like that, but the world can be a scary place sometimes. And so how if you're sort of predisposed to anxiety, how do we deal with those fears? And she had very good advice about that. So basically everything. I really hope this hits every question that you've ever had about anxiety.

I hope it's a comprehensive tool that you can go back to and listen to again when you're having bouts of anxiety. And one quick note, before we get into it at the end, I did a speed round with Ellen where I asked her for like her hot take on various supplements like Althenian and CBD and other anxiety alleviating practices. But I forgot to ask her about weighted blanket. So I just texted her and she said, and I quote, I am pro weighted blankets. I think they help with insomnia as well as anxiety and some sensory processing issues as well. So for what is worth, I personally Liz, not Ellen, I'm really pro weighted blankets. So I'm glad that she was into those.

You can find Ellen on her website, Ellenvora.com, and on Instagram at EllenvoraMD. We're also going to be doing a really fun giveaway. So make sure that you check out at Liz Moody for all of the details there. I think you're going to really love this one, especially if you love this episode. Finally, I don't normally ask for this, but for this episode, if you know someone that's suffering from anxiety, please, please, please send them this link to this episode. there's so much in here that I think could really help people. And as someone who's personally dealt with how terrible anxiety feels, I would just love

for as many people to have this information as possible because it really is life changing. Like so much of this type of advice has completely transformed my life and allowed me to live the amazing life that I get to live now. So if you know anybody who's struggling with anxiety or you know somebody whose partner struggles with anxiety or anything like that, please forward on the link and maybe they can get help from it too. All right. With all of that said, let's get into the episode with Ellen Vore. I really hope this is helpful for all of you. And if you have any other subjects that you want me to tackle with Ask the Doctor for future episodes, definitely hit me up on Instagram. I'm at Liz Moody. I would also

love your reactions to this episode. I'm really excited to share it with you. So definitely screenshot as you're listening, type in any like reactions or feelings or further questions you have and tag me at Liz Moody and Ellen, who's at Ellen Vora, MD. And we would love to continue the conversation over on Instagram. All right. I hope you love this Ask the Doctor special anxiety edition with Ellen Vora, MD. All right, Ellen, welcome to the podcast. Hi, Liz.

Thanks. It's funny because I feel like I'll often be like, yeah, like my friend, this person. And they're like a friend. I never say somebody's a friend if they're not a friend, but they're not like a friend where they like come to my husband's birthday party. and Ellen is actually that level of friends. So it's fun to get to have you on the podcast. I'm lucky to be that level of friends. It's really nice.

I'm very lucky, too. We just started recording after talking for too long. We covered all the good stuff in my living room. Two, was it like not suited for work? I feel like we're not suited for work as stuff. NSFP. Not super podcast. Perfect.

So let's just get right into it. What is anxiety? I don't know. How do you define it? So the way I think about all mental health issues, like I could come to an interaction with a patient and be like, well, the DSM says that if you meet six out of these 10 criteria, you meet the diagnosis or the diagnostic criteria for generalized anxiety disorder or this is actually an unspecified anxiety disorder. But like, who cares? That whole manual is really just designed to sell drugs. So the way I think about it is that people's subjective experience matters a lot more than checking those kinds of boxes.

If someone comes to me and they say they feel anxious, I kind of feel like, well, my job is done here, like in terms of diagnosis. Like that's someone's subjective experience. We're going to start from there. What do you think about the fact that sometimes people like to identify, like, I am a person with anxiety because it takes the burden off of them a little bit to sort of have that generalized overarching diagnosis? Totally. Well, yeah, I think we pigeonhole ourselves into diagnoses, and I think we've been taught to a little bit. It's an interesting and overall well-intentioned rebound from where we used to be, which was that mental health was shameful. You would whisper about it. You'd be like, yes, depression. And it's like, oh, for shame. But now, like, woke, zenial, like, gen next generation, it's like, we are very fruitful word about our anxiety. And that's cool. It's an improvement because we can talk about it. We can talk about treatment. But I think in some ways we've gone, it's not that we've gone too far, but I think that we have missed the part about mental health, which is to be hopeful about it. Like, we got taught that things are hereditary, chemical imbalances, and that they're permanent. So we think, I have anxiety.

I'm somebody with anxiety, and it will always be so. So I take this medication. I'll always take this medication. My whole practice is around the fact that you are currently experiencing the symptoms of anxiety. let's figure out what's out of balance in your body, your mind, your spirit, your life, get that into balance. And then it's really up for debate whether you still identify with anxiety. My favorite thing is when patients are like, I guess I don't think of myself as an anxious person anymore,

which can be a little bit disorienting, but it's great. Do you think that people have a predisposition to be like, I feel like I'm always probably going to react to situations with more of an anxious bent than like that would? Do you feel like that's true or no? We all have so many predispositions. Like it's a little bit genetic. It's a little bit epigenetic. It's a little bit what was modeled for us.

And it's a little bit like what was echoed back to us in childhood too. Like, you know, when people were saying to you as a three-year-old, like, you had separation anxiety. You started to develop a sense of identity around that too. And then we coalesce it for ourselves as we grew up and we think, I am this. So we've all kinds of predispositions that kind of stick us into certain grooves. It's interesting actually to think about, because I think I got lucky the thing you're talking about where my mom was in the hospital from when I was two to three. And I always, like,

I think I got lucky that I had a dad as a psychologist and sort of equipped to deal with that. But I almost wonder if he, like, could have over, you know, dealt with it and been like, oh, like, not wanting to have separation anxiety, not wanting to have attachment issues. And then I started to have those be sort of like core parts of my identity. I do think that psychiatrist, psychologist, like we do overcorrect things in our kids. I'm actively doing that in like 15 different ways right now with my daughter. But yeah, I think that, you know, it's better than not talking about it, though. But that's just tough, which you went through.

I don't think that there's any way to slice that where it doesn't impact you. Yeah. I think it's your life's path. But it's also like, let's be honest, it's why you are who you are and why we're here talking about what matters in life. Like, it's shaped you and it's tough your path, but it's beautiful for the world. I'm working. I think it's been actually something even just. in the last year where I'm, like, becoming grateful for not only, like, my mom's accident,

but also, and that even feels ickyer to say because it was such a big impact on her life and stuff like that. But for my time in London and the really intense anxiety experiences I had, because I'm like, oh, that is what sort of all culminated in me sitting on your daughter's floor. It's the quietest room in the house. Yeah, I think that, like, obviously it's usually kind of irritating. when people are like, everything happens for a reason. Like that feels a little too bypassy and unhelpful. But I think that it is a pretty life-affirming worldview to say,

I see how everything I've been through has shaped me and has been for my ultimate growth. Well, I think it just totally depends if you like the person you've grown into or not. Well, if you're not there yet, keep growing. Like, and really we all. Yeah. My favorite thing is just to look back at like, we can curse, right? It's like five minutes ago I was an asshole. You know, and five minutes from now, I'll look back at what I'm saying right now.

I'll be like, Alan, come on. So it's like you just keep, keep growing. Yeah, I love that. You talked about how one of your jobs, this is a question I got from a lot of people. One of your jobs as a psychiatrist is sort of to help people grow out of those definitions of themselves and in a lot of ways taper off of their medicine. I got a lot of questions about what people do if they can't find a doctor who's willing to do that with them. Yeah, it's really tough. So there isn't an easy answer to this, but here's how I help people navigate it when they reach out to me. It used to be that I was taking patients. I'm no longer really taking patients for individual treatment for the foreseeable future. But so I've decided to open up access by making these online groups. So it's like you're not really in individual treatment with me, but at least as a way of scaling, like more people can access this approach. Kelly Brogan, one of my colleagues and friends, also has a lot of programs that are like, let me give you.

you the information, even if you can't be in treatment with me. So she has something called the Vital Life Project and the Vital Mind Reset. Both of those are like online ways of approaching this information. If you can find a psychiatrist that will, is enlightened about medication tapers, then I think at the very least, you get the information, whether it's on these like scary medication discontinuation forums or whether it's through like my resources or Kelly Brogan's resources or mad at America's resources. And then you are in the driver's seat and you find a psychiatrist who's willing to be like, I don't know what to do, but I will support you. And then you're basically like, here's the confounding pharmacy we're going to work with. Here's the

percentage decrease we're going to do per month. And then you on your own or with a natural path or a functional medicine doc do all the other things to support your physical health. So, you know, on your own, you figure out how do you eat, how do you detox, how do you supplement, how do you meditate? That just, that feels like a lot to figure out. It's tough. I'm sorry. Yeah, so I always forget to kind of like back up and say like this is, it's, it's overwhelming.

And especially if you're dealing with anxiety or depression or any of this, it's like, Dr. Vora, it's hard enough to wake up in the morning, like, let alone shower. And you're telling me I'm supposed to meditate and supplement and detox and find a naturopath and navigate the system. And it's also overwhelming. I think that, you know, I love. like people, everyone's different. Some people are like, just tell me what to do. I'm so eager to start this process and they want to do 50 things at once. A lot of people, it's like give me one easy

shift to make and I will do that. And then maybe that will enable me to make the next shift. And so if that's the situation, you pick one or two really easy things at first. Like if you're dealing with anxiety, the first thing you do might be just get the phone out of the bedroom. That alone is a very impactful change. Would you say, I'd love to talk about sort of those low-hanging fruits for anxiety? Is that literally the first thing if somebody had anxiety and they came to you? Would you say get the phone out of the bedroom? Depends on the person. I do a lot of like witchcraft voodoo and read intuitively the situation. Think what's going to be like the most accessible, most impactful first couple of changes we can make. But I would say if we had to say just like

a one size fits all, I think getting the phone out of the bedroom, I've seen that be so impactful because it works on a hundred different levels, but mainly it improves the quality of your sleep because you don't get that exposure to blue spectrum light right before bed, because you don't get sucked in to Instagram or Netflix or geopolitical news right before bed, right when you wake up. And then all the associations we carry with it, like you don't want that close to you when you're trying to drop into a really vulnerable deep state of sleep. You kind of want those associations with stress and reward and online dating and work email out of sight, out of mind.

So setting up your charger in another room, getting the foot out of the bedroom, really huge. Other extremely low-hanging fruit is like to get a squatty-potty. Like just improve your digestion. I have, okay, so I have a squatty-potty, as you know. It doesn't like work for me. I wonder if I'm too short. Higher one. Maybe I need a higher one or you have the low one.

Like normal, the basic one that you order. And Zach says it makes like a world of difference. Wronger legs. All that happens for me is my legs go numb. Oh. Yeah, that's definitely not right then. Yeah. So, yeah, I think you want to get the nine-inch one.

Okay. I think it comes in a few different. And then we have like a two squatty-potty home for our tiny. We have a three squatty-potty home. No, but you have three bathers. No, sorry, four because we have a travel one. Yeah, I think that it is, it's worth, I mean, it's a $24 purchase. It's worth kind of tweaking to get it right.

Why is elimination and pooping just so for everybody listening, a squatty potty, you may have seen the fabulous commercials where there's like unicorn rainbow poop, but it helps you eliminate better. And why is eliminating better so important for anxiety? Basically because that the gut is the seat of our immune system and our mental health. And the immune system is itself keenly related to our mental health. And you want that functioning as well as it possibly can. And it's really compromised by modern life. Modern life, everything from the antibiotics we take and the crappy food we eat and our chronic stress all the way to the fact that we sit on thrones, which causes this partial closure of our sphincters, and then we're pushing

through partially closed sphincters, and we're not having complete evacuation. So then there's sort of backup, then we reabsorb toxins into the bloodstream, then we get IBS, where we alternate between diarrhea and constipation, and just the whole thing doesn't work. So complete evacuation every day is facilitated by anatomic evacuation, i.e. squatting, using a squatty potty. And once your digestion is flowing, your serotonin production improves, your detoxification improves, you feel better. You're not going to have this sort of overgrowth of bacteria, which can contribute to inflammation and leaky gut. And then you're leaking inflammatory compounds into the bloodstream and making our brains inflamed and making us anxious. So that's like,

kind of like in the weeds a bit. But basically, if you poop better, you feel better. Yeah. Give me one or two more low-hanging fruits. Magnesium is a very low-hanging fruit. So magnesium glycinate, or if you want to get fancy about it, magnesium-3-8, taking something like... Wait, what's that?

I don't know. I don't even recommend it because glycinate works. Okay. Keep it simple. Magnesium glycinate, 400 to maybe 800 milligrams at bedtime, can help a lot with sleep, a lot with anxiety. It also helps with their digestion, your cardiovascular health, and your longevity. I love magnesium so much. It's one of the few supplements I take where I feel a real difference, like in the moment.

In the moment, yeah. I notice when I miss it. Yeah. Like, if I don't take it for a few days, I kind of have, like, the wigglies when I'm trying to fall asleep. My favorite way to take magnesium is actually an Epsom salt bath, which kind of works on a few different levels, but that's basically taking a supplement through your skin to absorbing it. And it's pleasant and relaxing. Is there anything you need to take with magnesium to, like, balance it? I'm always, like, nervous about isolates. did that's above my pay grade like people have different theories on that like calcium magnesium i don't think really anybody should be supplementing with calcium so i don't do that cal mag thing yeah cal mag fos um why do you not think anybody should be supplementing with calcium you know it's always been an intuition that eventually like maybe five or six years ago there was some research to back this up but it just feels like we live in an era where the one of the epidemics is just that we're calcifying

our arteries and our microvasculature and so i feel like i just don't want to be adding to to that problem. I don't think it's super natural for us all to be consuming dairy in adulthood. So I just feel like we are erring on the side of too much exposure to calcium. And then we do that in combination with inadequate vitamin D because none of us get enough sunshine. So I just think it's a bad recipe for human physiologic balance. What do you think about people asked about other supplements? Because I think people hear a lot about magnesium. Are there other, like, do you recommend vitamin D supplementation for people with anxiety slash? people in general? I recommend getting your vitamin D supplementation from like the sun, and that

one's controversial, but I think that obviously this is a personal thing. Everyone needs to figure out their balance of the benefits of vitamin D with the risks of skin cancer, and those are, and then premature aging, which is a vanity risk, not a health risk. But I think that, you know, everyone, it's a different balance. It's based on how fair you are. It's based on your family history and, like, how, you how much you're genetically at risk of having skin cancer. But I think overall, we are a species that evolved outside, getting a lot more sun exposure than we do today. We've thrown the baby out with the bathwater with sun exposure. Like right now, we're just like cover up and like you see moms at the beach like slathering their children and no one gets any sun exposure. So we're all deficient

in vitamin D. Even those of us that are like a little tan, we're deficient in vitamin D. And I think a problem is that we go pale, pale, pale, pale, pale, pale, then you take your vacation and you get a Sunburn. I think that's putting us much more at risk of skin cancer than if we have a low-grade little bit of melanin, like just a little bit of a tan on all the time. Okay. So what about when it's like 30 degrees in New York in the winter? I'm not going to say go to a tanning bed, but I think get sun exposure somehow. And it's interesting. Like tanning bed is considered like you completely cannot recommend that. It's like, you know. I remember when you first told me that you did it and I was like a gas. I was like, you went to a wild. What? And then I told my other doctor friend about it, and he was like, oh, yeah, that's a good idea.

I mean, it's pretty much synonymous with, like, smoking cigarettes, right? But I think that, and, you know, just to clarify, it's not like something I do in an ongoing way. But the last couple winters, I've done it like twice per winter. And I don't do it egregious. I don't come out like orange. I do it for, I think six minutes. But I've decided that for me, it's net positive that I get a little bit of my skin actually producing vitamin D the old-fashioned way. It boosts my mood. It helps me the seasonal affective disorder. I don't tempt fate. I don't like play around with getting tan or burned. And it feels net positive.

And I go from my annual screenings with a dermatologist. And do you have your vitamin D levels checked? And are you sort of in a good range? I used to, I don't know. I used to be so much more like into the functional medicine, masculine, objective numbers. I have so much less into it now because I think I keep more and more getting good. Well, first of all, I'm too busy to do all that stuff. But also I keep getting better at intuiting.

Like, I think my body tells me when I need more sun, when I've gotten enough, when I've gotten too much. Like I feel very connected to the hotline of my body communicating to me. If you have a patient come in, like a new patient, do you run panels on them or no? Not anymore. I used to. I used to do lots of lab testing. It felt like me practicing good functional medicine. At this point, it's so much more energetic and witchcrafty in my practice. But occasionally, I will do some blood work. And more often than that, I'll refer out to a functional medicine internist or a naturopath so someone can be sort of doing the masculine objective work while we're kind of doing the psychospiritual work. How do you determine then if something is sort of at the root cause of somebody's anxiety, if they're having a hormone imbalance or they're having a more serious gut health issue or something

else like that? Yeah, I think that like blood work is a nice way of putting a number to those things, but there's so many ways the body tells us that those things are out of balance that I feel like it ends up being a redundant data point anyway. Like someone's, many, many times hormone imbalance is at the root of anxiety, especially in women. And like, their body is telling me that with acne and irregular periods and really painful cramps and all of that. Like, we're getting that information as if a snapshot of their hormones at any given moment of one day is going to give us more useful information. Like,

to me, that's more specious data because that changes moment to moment. So what their, how their body is functioning to me is really the data. So if somebody's at home listening and they're like, I wonder if hormones are at the root of my anxiety, what would you tell them to look for. So irregular periods, all kinds of hormonal patterns of acne, really severe so-called PMDD, or like really severe mood crashes before your period, really heavy cramping, really heavy bleeding, really light bleeding, any kind of worrisome, concerning signs for endometriosis. Like, I think all of this tells us that hormones can be at play. And what would you do if a person came in and had hormones underlying for their anxiety? Yeah. We, we.

chip away at that in a number of different ways. One is that I, um, like, slowly, gently help people shift their life away from exogenous estrogen exposure, which is a project. You know, that starts with, um, you just want to little by little avoid the ways that we're getting exposed to exogenous or outside estrogens. That's in the form of pesticides. So eating organic food. Plastics are not drinking water from plastic water bottles or microwaveing your food in a plastic container. Um, And then in personal care products and makeup and perfume, like all of that is endocrine disrupting. And the translation of endocrine disrupting is it's getting your hormones out of balance.

And then conventional cleaning products. And so sometimes people want to- Or that sort of the big four, though. If you kind of get those areas, you're probably drastically reducing your estrogen. In the ways that are controllable, like air pollution is tougher. And then, of course, like birth control pill is sort of like the big cahoom. know, but that one is a bigger, that's a bigger ask. You know, if someone's relying on birth control pill for their contraceptive, it's a longer

conversation. But if someone is on birth control pill and anxious or depressed, to me, it's playing a role in their anxiety or depression until proven otherwise. This is the classic thing where it's like the systemic misogyny of the medical system where for decades, women were like, huh, it's weird. I kind of got depressed and anxious when I started the pill, if we even thought to attribute that shift, but chronologically it often lined up. And the medical system is like, no, silly woman, you don't know you, I know you.

There's no evidence of that. And then finally, now there is evidence of that. But so, you know, birth control is a whole fraught issue because we don't have a perfect solution. We truly don't. I know we don't have a perfect solution. I like your solution. I like my solution. And it's crazy to me that it took so.

So I had normal birth control, like the pill. And then I did, I had a morainea for seven years, which is the hormonal IUD. and then I went off that about a year and three months ago. And we do condoms when I'm fertile and we do no condoms when I'm not fertile. So we get to have like condom free sex. And I'm very conservative about it. But we still have condom free sex like 10 days a month because when you're on your period, it's almost if you have a somewhat regular cycle from what I can tell.

If you're on your period, you're pretty much good to go. And it's great. Like he has to wear condoms about half the time in the month. But he also gets to have condom free sex. sex half the time in the month. And it's otherwise I'm putting hormones my body every single day of the month. So the only pitfalls of like, so you're basically doing a device supported form of fertility awareness method, right? Yes. And like I love fertility awareness method. I wish we taught it in seventh grade to girls because imagine if like 12 year old girls were learning how to get intimately

equated with their bodies, with their anatomy, with their cycle, if they knew their cervical fluid in their cervical position, if they could sense when they're ovulating and when they're right before the period. Like, if we knew that information, it would be so empowering, it'd be so beautiful. The pitfalls are, one, it's obviously not SDD prevention, so like condoms. But yeah, birth control isn't either. Like, right? No, certainly not. And it's only as good as your cycle is regular, which, like, if you're a 28-day clockwork person, you can effectively prevent pregnancy with fertility awareness method. The tricky thing that I have when I'm, like, recommending it to my patients for, like, in their 20s and not in a relationship is sometimes, you know, you know,

your cycle is clockwork until it's not because you got really stressed that month or traveled across time zones or had a lot of dietary changes. And sometimes it's hard to predict that. So I just worry a little bit grand scheme. Like I think that it's better to be in a situation where if you were to get pregnant, it wouldn't be so life altering. I'll be the first to admit, like, I have a daughter because I was a little casual about fertility awareness method. I'm happy about that. But yeah. I do feel. feel like I am anal about it. Like I'm like, you take your penis over there when I am even four or five days,

like on either side. So I do think there's ways you can be more or less casual about stuff. But yeah, I do think that that's true. Also, I don't know how they do it, but natural cycles did. They're not my sponsor anymore, but they worked with a podcast for a while. And they say that they work with irregular periods because of their like algorithms and stuff. That's great. What I recommend to people is to spend, I think it's $10 a month.

So if they do have an irregular period and they want to try it to go with something like natural cycles, which I like. I wholeheartedly agree. And if you are in a situation where pregnancy would be life altering or STDs or potential, you basically want to do fertility awareness method paired condoms. And the fertility awareness method, I kind of feel like we should just all be always doing that. Like, I'm not really actively trying to do anything with my fertility right now, but I want to always know when am I ovulating, what I'm about. And it's crazy how much you can tell. Like, your mucus or, like, whatever the discharges, it legitimately changes. Legitimately changes. And I don't, I'm, like, sort of proud of my, I feel like I'm more in touch with my body than I've ever.

Just from the year, I'm like, look at my discharge changing. Like, you go discharge. Like, I just feel very, like, in tune with everything. And how did I not know this about my body until I was like basically 34? Yeah. It's really disturbing. And so, and like this is, this ties into like the recent, like the hating on goop and all of that. I mean, that could be the whole podcast of itself. But basically, like, women are dangerous when we are empowered and knowledgeable and in touch with ourselves. And I think that it's not like, I don't even want to give the patriarchy credit to say like that they had forethought into thinking like, don't teach women fertility awareness method because they'll be too powerful.

But I think that like we just hand over. our power in every direction constantly. And I think it is certainly true with birth control and our hormones. Although that's, I think that's why birth control is a tricky conversation because it came out and was the most empowering thing to ever happen to women. And I think we burned our bras and then we're like, wait, maybe it's more comfortable. Actually, like a soft, comfortable sports bra. Oh, no, I'm a no bra girl. Are we both sitting here? Yeah, just like nipples blazing. But I do think, I think that's why it's such a, because it is really empowering. And I do, but I just think the conversation then

needs to be like what are other ways you can be in control of this because that's why it was so empowering in the first place. Okay, but circling back to hormone balance. So that was the sort of taking care of the estrogen exposure, the excess estrogen. Most women who are out of balance with their hormones, it's a couple likely culprits. And one is estrogen dominance where we have sort of excessively high levels of estrogen because of all the estrogen exposure. And then excessively or falsely low levels of progesterone. And that generally has to do with chronic stress and nutritional deficiencies. So when we're chronically stressed, the same precursor that makes progesterone also makes our stress hormone cortisol. So when we are chronically stressed, we're shunting

that precursor, pregnant alone to make cortisol, cortisol, cortisol. And we never have enough left over for progesterone. And it's one of the beautiful checks and balances in the body. The body basically says, you shouldn't get pregnant. Exactly. If it's, if the war is on, like let's triage away from fertility. I think it's a good design. But now we live in this life where we're chronically stressed because we have intense jobs, but we also so stressfully want to get pregnant, and it's sort of like, you know, it really ends up being a lot of suffering for women. So I think that the more you can practice some way of getting your body in a relaxation response on a daily basis, whether that's that you actually meditate or do yoga nidra, or just do less and don't like buy into the whole

like stress industrial complex that helps your hormones get back into balance. How does one not buy into the stress industrial complex? Well, gulp. So. And can you explain a little bit what that means? I always worry because I think that there's a certain amount of like privilege safety net that has allowed me to have wiggle room with this in my own life. But for myself, I went through med school. I went through residency.

I went through more intense jobs in the health care field. And I was like in a prison of my own making and basically like, Oh my God, I'm so stressed. Oh, my God. I have no time. Oh, my God. I work overnight and on weekends and on holidays. And I feel like at a certain point, I realized I could walk out of this prison. There's no, like, the door is not locked. And then I was like, what if I actually design a practice and a life that feels right for me? So I designed a different life. I went into private practice. I practiced in a way that was in alignment for me. I say no more. I do less. What ends up happening is that I make less money, but, I went into private practice. I practiced in a way that. I practiced. I practice. I practice in a way. I practice. I practice in a way. I practice. I practice. I practice. I I need less money because my life is in balance. And I think a lot of us are on a bit of a self referential treadmill of like you need to make the money because you need to afford all the ways that we deal with our burnout. And, you know, therapy is expensive and retail therapy. Yeah, yeah. Or like you're like, you're working yourself into a frenzy and then you're like, well, I'll just buy the supplement that we'll fix it. Exactly. Or the expensive cocktail or the

vacation or the therapy or the massage and so on and so forth. So I just make less and do less now. And I'm just happier and more of a state of balance. But some people are genuinely in a state where they do not have any wiggle room to play around with this. And I get that. And so I think that that, you know, that's tough. I think that I'm more speaking to there's a swath of people that have more wiggle room than they realize because our culture tells us keep striving, keep hustling, say yes to any promotion, say yes to any project, go for the most prestigious, job and people just default setting say yes, yes, yes, yes, more, more, more. And I think for those folks, experiment with essentialism of basically like saying less and doing less, or doing less

saying no. And I think that for people that are truly just paycheck to paycheck and just make ends meet, it's tougher. And then I think that it requires a different kind of a shift. But we live in a world right now. We're like the people at the top, not that they're happy your balance. But like they make a lot of money off the fact that we're all burning ourselves out. So just to recognize when you're a cog and somebody else is Uber wealth and just to kind of step out of that. And what would you say if somebody was like I need, I'm a working single mom. This is my, my life is stress. Yeah. No, I get it. A lot of my patients are in exactly that situation. there I'm looking more for ways for people to feel supported that don't cost a thing.

So, like, there you need community. There, you need good friends. There, you need to recognize, like, who can step up and help you. And then there are ways to save money that I think are just culturally less thought of. Like, food is so expensive. It's so expensive to eat well, except if you want to take it into sort of, like, buy dried, sprouted lentils and dried rice and just, like, that's your staple. It's like you make kitchity and get some first.

frozen spinach and like that's your vegetable and you can save money and eat real food and that starts to help your health that maybe that starts to help your productivity and I do think that there's room for energetic shifts no matter how much your paycheck to paycheck but sometimes you have to like kind of shift something at the root of it all I think usually we just need community and support because if you're just drowning or treading water like you can't get your head above water so it needs to start somewhere and usually it's support I think the community question is so interesting because I think we, like I talk all the time about how I think we're in a loneliness epidemic and we have such a dirt of community. But I think it's harder to find community than people give it credit for.

So what do you do if somebody is just like, I'd like to have community, but where do I get that and how? Yeah. So in my own life, the way I solve for that is I do think that like loneliness is the epidemic. And part of what we do is we host and we lower our standards for what it means to host people. So, like, if you picture what it means to host someone and, like, it's a good example. Because when you host someone, you pour love and time and resources into, like, making a nice meal for them. And that's a beautiful thing. And thank you.

Because I feel like they're going to judge me because I write cookbooks. Oh, well. So I guess no one is going to judge me for my lack of cooking skill. The thing is, is that I want community and I want to facilitate it. I want it for myself. I want it for the people in my life. So I say, come over. I have nothing to offer you.

My house will be a mess. We will order takeout, but we will hang out. And we will sit around my messy living room and eat out of like cardboard takeout containers, but we will hang out. We will have community. So I've had to make it realistic for myself. And I think that there's also this issue right now, which is that I think there's two universes that people operate in.

you either look around you and realize everybody around you is an asshole, or you look around you and you realize everyone is a freaking goddess that is just like has a heart of gold and you can't imagine how amazing people can be. And I think that if you are in the asshole universe, you have to switch. I was in the asshole universe when I was younger and like I looked around me. All my friends are assholes. I was an asshole. We were bringing out the worst in each other. And I happened to move into an apartment with my now husband. And I looked around and everyone had a heart of gold.

And I was like, wait, everything changed. And so if you're in the asshole universe, you basically, like, even if you hate yoga, you like go to a yoga class, like start to see that community in action. Maybe you go to a community free meditation night. Maybe you go to a church. Maybe you go to a volunteer event. Like, you basically try to seek out where are the good people hanging out? Because you want to be around the people that, like, that good is the goal.

That being kind is the goal. And there's like, you just want to, you want to exit the asshole universe. I felt like that, we talked about that after Zach's birthday because a big part of Zach's birthday party was there was these like silly dares that we had people do, including like, you know, performing a song for Zach and stuff like that. And every single person was so down and just like down to have a great fun, spirited time. And it just like, I was just like, it's so lovely that we have all these people in our lives who aren't like, I'm too cool for this or like, like, even this. song. We have this cute video of when you guys were performing the song for Zach, and Vimel, your husband just like hops off the couch and is like, I'm going to sing the song too. Like, you know, she's like, of course I will. And I just think it was this really nice moment of being like, being too cool for something is such a overrated thing, you know? Too cool. It's not yet canceled, but it will be soon because I think the cool people have started

to recognize that, like, the people that are living goofy and playful and vulnerable are having a better time. Yeah. So like the, and like this is to your and Zach's credit, right? Like, you make it safe and comfortable for people to be goofy and playful. You made that exercise. That's a very playful thing to do. And it's disarming.

Like, it lets people play. And like, like, if you just stood around and everyone was like looking cool and taking Instagram selfies, like, gross. You know, it's not fun. Yeah. How do you, I think that that play, being playful as an adult is actually one of the best antidotes of anxiety that I've found. do you think there's easy ways for people who are maybe a little bit less comfortable with that kind of stuff to bring that playful childlike spirit into their life?

Yeah, well, I think like dogs make it easy. Children make it easy. Get a dog. Get a dog. Get a baby. Don't just go and get a baby. That has its other downside. And then like game nights.

So like sometimes I think I had to grow into comfort with this with some amount of structure. And so like games basically give you license. It makes it the rule. that you're supposed to be goofy. So we played that game moniker, right? Which I grew up calling celebrity or salad bowl. But there are rounds in there where you have to be goofy to get the job done. And so it's like, oh, I'm cool, but I have to be goofy right now.

And it gives you license to, it gives you permission to. And then you end up having fun. So other than hormones, is there any other physiological things that tend to underlying anxiety that you see regularly? Yeah. So I want to talk about blood sugar, caffeine, and sleep. So an alcohol if we can? Yeah, we can piss people off.

Okay. So blood sugar, this is the most under the radar, but increasingly above the radar, impactful thing. To me, panic disorder, anxiety issues is a blood sugar dysregulation issue until proven otherwise. And meaning it is that common. It is that common. It is that fixable. But we all run around on a blood sugar roller coaster because the American diet is built

on a foundation of what, like, our coffee drinks are really just milkshakes and refined carbohydrates and rosé. And so we're all just like blood sugar crashing constantly. And a blood sugar crash causes a stress response in the body. That's just the design of it. That's the system of checks and balances to prevent us from dying from a blood sugar crash. And so we pull the cord of adrenaline and cortisol that alerts the liver to break down its glycogen stores so that we have blood sugar again. It saves the day, but it leaves us rattled because we just had a five alarm fire in the body. And so a blood sugar crash produces a stress response. A stress response feels synonymous with anxiety.

And for some people panic. So basically I get my patients to do the like hack and then the definitive solution. The hack is to do something like a spoonful of almond butter, a handful of almonds, a spoonful of coconut oil or ghee, whatever you can do to give yourself a little bolus of fat and protein at regular intervals throughout the day and before bed. Is there an amount of like fat and protein that you would tell? people. I do not do numbers. Just like about a spoonful of almond bread. Because it all ends up meaning to be intuitive anyway, right? Like it needs to be like, this is what feels right for me. Absolutely. But I do think that people are, it's way harder to be in touch with that than you might even be able to connect to. Totally true. What I do in my life is I take a spoon out of the drawer

of spoons, dip it in the alma butter jar, and put it in my mouth. So whatever that is, I don't know, 20%? But some sort of fat and protein, just a pretty small amount. Yeah, and it can be pure fat too. Um, and so then, um, that's the hack, the definitive solution. And how often do you do that a day? So it depends on the person. I've had a patient who was, um, had severe bipolar disorder. They were a very what's called brittle bipolar, like they were having severe manic and depressive episodes. He had been hospitalized many times. He was on heavy duty meds. Um, and he is now fully off meds. And the only way he's managing his bipolar is through MCT oil and coconut oil spoonfuls every three hours.

So he basically just keeps his blood sugar airtight. A lot of my patients, it's more like they do it at 3 p.m. and 5 p.m. and before bed. So for everyone, it's a little bit of a different sweet spot. But generally every three to six hours and you start to gauge yourself, you start to learn, oh, I have a predictable pattern of blood sugar crashing at 3 p.m. or right when I get home from work or at 2 a.m. And so you start to anticipate it and kind of stay ahead of the eight ball. And you do the spoonful a little bit before that.

That's the hack. The definitive solution is rehabilitating your diet to real foods and avoiding fake foods. That one's easier said than done. Well, that's interesting too, though, because you've also sort of changed your dietary perspective, even since I've known you, you've shifted in, like, not being as hardcore. Like the kitchens, I don't think, would you have eaten that when I met you? I think I would have, I've always eaten it because I was always married to this staunchly ethical vegetarian.

So there's no way around kitcheny in my home. Well, he's changed his diet way more. Yes, he has. Ellen's got her husband, a vegetarian eating meat, which is interesting. Because I think it's an interesting perspective. He's not going to be happy as is going public. I'm not sure he's told his family yet. Just kidding.

Just recently. I do think it's interesting that you can, you, you are in love with somebody who was an ethical vegetarian and still has a lot of those ethical beliefs. All my boyfriends have been ethical vegetarians, except for the one asshole. one who's not listening. Is that a weird thing for you? Well, I think here's the thing. I mean, we could go in so many directions right now.

I think ethical vegetarianism and veganism is a marker for someone who's really reflective, who's really viscerally connected to the welfare of all living beings. It's someone who's like making conscious choices going against the grain. It used to be against the grain. You know, now like in L.A., it's against the grain to eat meat. Yeah. But it used to be against the grain to be awkwardly the vegetarian. and I have always sought out men who are reflective and conscious in that way.

I was myself an ethical, vegetarian, and then vegan. And it wasn't until well into getting like my life, my health spiraling out of control that I realized if I reincorporate meat, especially red meat, I feel better. And so that was a really inconvenient truth and something to grapple with. I am slaughtering animals and I am now able to be healthy enough that I can fulfill and carry out my purpose on this earth. So I still grapple with that all the time, but I did convert my husband.

You're listening to the Healthier Together podcast. So Zach has been traveling a lot for business, and when I'm left alone for dinner, I don't often feel like making a whole meal. Sometimes I will, I'll treat myself. But more often than not, I'll just kind of like snap my way through dinner time, eating a bunch of disparate foods while sprawled out on the couch with my cat,

watching a TV show that Zach would definitely not enjoy. So for those nights, my Simple Mills crackers are an absolute lifesaver. They have two types. They have an almond flour, sort of small square shape, and then they have a hexagon one that's made from sprouted seeds. They both have three grams of protein per serving plus plenty of healthy fat and Simple Mills's signature, super short, recognizable ingredient lists. But I would say if I had to choose, if I had to choose, the almond flour ones are usually

my go-to because they come in a ton of fun flavors like black pepper. That is my favorite one. and then rosemary and sea salt, which is so good. And also they're so good for, like, dipping. They're really sturdy and I'll snag some hummus, like whatever good dipping sauces look good, some cheese. And then I'll have a little, like, poo-poo platter of magical deliciousness. Also, hot tip.

This is like one of my favorite healthy cooking tips. The crackers make an amazing sub for breadcrumbs in pretty much any recipe. You just pulse them up in a blender or food processor, and then you can use them as a way to bread chicken or. top pasta, maybe with some like garlic, that'd be so good. You can use them to bulk out meatballs, anything that you would normally use breadcrumbs for, you can use these Pulse Simple Mills crackers for and it makes it way healthier. So like all Simple Mills products, they are free from grains, gluten, dairy, corn, weird gums or emulsifiers. They're just, I don't know,

they're dreaming. I love Simple Mills. I love their crackers. You must try them. You can find Simple Mills products at Costco or you can get a whopping 20% off your order at Simplemills. using the code healthier together 20 when you check out. That is the name of this podcast, healthier together, the number 20. Use that when you check out. Order all of your amazing Simple Mills products. They're one of my all-time favorite brands. And I cannot wait for you to try them.

I know that you're going to be completely obsessed. All right. Let's get back to the episode. So what does an ideal diet for if somebody's experiencing anxiety? What does that look like? So like it's all these considerations, like ancestral, like your gene. have an influence on this. If you're South Asian, you're probably more likely to do well on more of a vegetarian diet. I love the blue zones, the way that informs this, that like if you look

around the world, the healthiest populations seem to be sort of semi-vegetarian, or like to borrow Mark Hyman's term, it's kind of plegan. Like most of us need to be eating more vegetables and less meat, but not no meat. And most people who are in the health and wellness world have kind of gone too far down the plant-based. And it's like so beautiful, like it's like almost entirely right, like more vegetables, more plants, more prana, but then the complete absence of animal foods, for some people, especially women of reproductive age, especially women who are sort of parasympathetic, dominant nervous system, the artists, the intuitives, the sensitive types, the anxious types, they're usually the ones that actually need more red meat,

but they're also usually the ones that are so sensitive and conscious. and viscerally connected to the welfare of animals that they're the ones eating no meat. So I think that, like, I sometimes walk by the butcher's daughter, which is this very trendy vegan restaurant. And I just want to, like, it's now a vegetarian restaurant, I think. I just want to hand out my business card and be like, eat meat, eat meat, eat meat, eat meat, because I see all the anxious women there. Let's speak to the person who's listening who is vegan and they are not going to change that. Yeah. Is there a hack or ban?

Always, totally, yes. So there's always harm reduction. There's always the needle exchange program. And I think that if you're not going to change that, well, let me say, if you're a vegetarian, for ethical reasons, environmental reasons, religious reasons, whatever it is, incorporating more ghee, more egg yolks, if you tolerate egg yolks. And if you tolerate dairy, like more like full fat, kaffir, foods like that, you can go a long way with that. So like plenty of kitchens, you cooked with plenty of ghee, lots and lots of egg yolks. Maybe a supplement would be 12. You can do pretty well.

Just because we've said it like three times now. Kishy is it's a, it's like a mung bean rice, right? Yeah, it can be mung bean or yellow spithal. It can be lentils. It's used often in like Ayurvedic cleanses. It's tri-doshic, it's gentle, it's digestible. Triedoshe, meaning like for anybody's constitution, it's considered Iovetically good for it. It's a really great, maybe I'll link a recipe in the show notes. That's a good idea. But it's really hearty and delicious.

And it's dirt cheap and easy and nourish. And it's kind of all you really need to have around. Okay. So that's vegetarian, but what if you're like vegan? If you are vegan, so some people, I think, do basically okay on an extremely plant-based diet, people with a sympathetic dominant nervous system, the surgeons and the marathon runners and the people that are just like life naturals and good at life. And I think that there are people that can do well.

I'm thinking like rich roll. Yes. Yeah. Okay. Yes. But that doesn't mean it's universally generalizable. Ethically, totally the way to go. But in terms of people's...

Yeah. But I think that in terms of people's constitutions, not for everybody. So if you are vegan and you are having irregular periods and you're anxious and you always feel cold and you're not sleeping well and your hair is falling out, like it's probably not working for your constitution. But if you are like suddenly feeling clarity and lightness and you run farther and jump higher and like then it's working for your constitute. Although I always think that's really tricky because I think that so many of the testimonials

for all of the diets, it's just people who went from eating crap to eating paleo or eating crap to eating vegan. They're like, I feel amazing. It's like, well, yeah, like anytime you stop eating potato chips and start eating like broccoli, you're going to feel great. Yeah, this is the Mimel's point always like that shoots us down when we get into the nitty gritty of comparing the different diets. It's like anybody who's just eating more vegetables and less processed food feels bad.

So take your pick of the whole buffet of different tribes. So just to like round out the vegan thing, though, if somebody is having their hair falling and they're still like, I'm going to be vegan, is there something they can take something like a supplement or something that they can do that would help fill those holes if they have anxiety? They don't feel great, but they're like, I just cannot eat the meat. This takes me back to the days, like early days when we're working together at Mind Body Green and you kept pushing me like, but what about the vegans? And I kind of want to say like B-12, collagen, sneak a little bit of meat, like, eat some bone broth. I think it's tricky. I think that I just, like, I'm probably over-emphasizing this because I'm biased because of my own personal experience. I was vegan and I've never, and at first I felt awesome and then I've never been so unhealthy.

And it took a real like coming to Jesus moment to realize like, fuck, I have to eat some meat. And then everything fell into place in my health. in my life. And it's still something I grapple with and it's tricky. And I come up against this with patients day in and day out. But I think overall for women of reproductive age, whoever at all, that kind of sensitive, anxious type, some amount of incorporating animal products is sometimes necessary. But that's only if we're looking at optimizing health. So if you're really like, I'm not here to optimize health. I'm here in service. I'm here to cause as little suffering as I possibly can. Then maybe recognize, just make a conscious choice that you are compromising your

health in order to live in that way and that's a beautiful thing. Okay, so walk me through what your ideal anti-anxiety like day on a plate would be. Day on a what? Day on a plate. Like the day in food. You're just like wake up in the morning and you're like, I'm going to eat in a way that will make me have the least anxiety all day. On a plate. On a plate. Okay. Or in a bowl. Okay. Or like sitting in front of your fridge. I first heard day on a plane and I was like, well, to not get anything for most people with anxiety. But so day on a plate. Um, Okay, so in the morning, well, the thing is, is that I'm a realist. Like, there's the optimal way to eat, which usually involves having a personal chef and they, like, hand you your tri-doche. Do you like an optimal with, like, realist modification? Totally. So for anybody who's like, I have no time in the morning, then, like, call it intermittent fasting and, like, drink your bulkproof coffee or decaf coffee if you have anxiety. If you have time, like, what I do is oatmeal. And oatmeal is, like, oatmeal is, like,

not like paleo template, but I get gluten-free, Bob's Red Mill, quick-cooking oats, have that with frozen blueberries, frozen cherries, pecan pieces, and cinnamon. And that is quick enough. I microwave it because that's realism for me. And then I eat that. And that seems to give me the right balance of like it's not a blood sugar spike and crash, but it's also not, it doesn't take too long to make. I go through phases of smoothies. I think smoothies can sometimes be a sugar bomb and they can sometimes be a cold bomb. And so you want to kind of be conscious of both those things. A cold bomb, not the sort of darling of Chinese medicine or Iyerveda, but I think that if you are living in a warm climate, a smoothie here and there is probably okay, but don't add

ice. Yeah, I'd never add ice. I think that's the biggest, you can have smoothies that are sort of more close to room temperature. And I think that that feels, you feel a difference in your body. Whenever I, like, out and I have to order a smoothie, it never feels as good. Yeah. It chills me to the bone. So I think that, like, if you have infinite resources, just use fresh berries. If you don't, use frozen berries, but maybe hot liquid. That's what we do. So we'll use frozen berries because it's more affordable, but then we'll actually make our smoothie

with our herbal tea that we've steeped that morning. Can I also just blend it a little longer. Blending is, like, warming it up. Friction, yeah. And so if smoothie is working for you. Do you think having warmth in your system is important for anxiety in the morning? Room, temp and warmer, because anxiety is so often a Vata exacerbation state. Not always, but usually it's people sort of prone to that Vata imbalance who are in a state

of Vata imbalance. And so I think that you just want to work on warming the system. And that can be everything from warming spices to wearing scarves to avoiding cold foods. Okay. And then that also helps with your digestion. And that in turn helps with anxiety. Okay. So that's your breakfast?

Yeah. And it can be a smoothie. that's what's working for you. But in general, is there like a check, like, break? You want a protein? No, you don't, you didn't even say protein for those. You know, I throw nuts in my oatmeal. I would throw collagen in my smoothie. I wouldn't mess around with too many Franken food protein powders personally. I think collagen is as like supplement form as I'll get with that. And then, but like if someone wants to cook some eggs with spinach or cook a sausage in the morning, I think that's fantastic. To me, that's like six minutes I don't have. But I really,

respect when someone does. Okay. So something that's not too cold that has protein, a good amount of fat, and is just going to sort of fill you up in the mornings what we're looking for. And it also, all of your examples, has some sort of fruit or vegetable. Is that like necessary? I think that over the course of the day, I think the ratio should be generally a quarter of your food is some well-sourced protein. A quarter of your food is some kind of starchy vegetable. And about half of your food is mostly vegetables and some amount of fruit. And I think if each meal doesn't have to be exactly that balance, but overall you're aiming for that, but you don't have to adhere to that dogmatically. And then in this perfect anti-anxiety day, are you, like, drinking a certain tea?

Are you drinking coffee? I'm personally drinking herbal tea in the morning. Coffee is one of these things, not an inherently bad substance, but if you're interested in listening to this podcast because it's about anxiety, there's a good chance that you're a slow metabolizer of caffeine and then it makes you jittery. So if you're someone who can have the shot of espresso after an Italian meal and still sleep that night, good for you. Enjoy your life. That blows my mind.

Enjoy your life. And then if you are somebody who's like, I had one too many refills of coffee at brunch and now I'm effectively on caffeine or on cocaine, like I think that that's, you're a slower metabolizer and it's probably contributing to anxiety. So for most people who struggle with anxiety, it behoves them to at least do a trial on less caffeine or no caffeine. But PSA is that you make no changes rapidly around caffeine. You go gradually because it's a real drug with a real withdrawal and be.

Being in caffeine withdrawal is no bueno. So, like, for me, I was down to a cup of day of green tea, and I wanted to get off of caffeine. And I tried, and I got massive headaches. And so I went back to my cup of day of green tea and then tapered off gradually over the course of a month. And so I... It's crazy. I think, yeah, it's whatever rate you need to do to avoid feeling irritable and headachey and grumpy and hating the world. How do you feel about decaf coffee?

I think of it as if you get so much... much joy from the ritual of coffee, like the smell, the feel, like that if you have a crush on the barista, whatever it is, like, then go to decaf and enjoy the ritual without the caffeine. Decaf itself, not a perfect substance. You know, sometimes it's using a chemical process to decaffinate it. Sometimes it's quite caffeinated. Like, I wish I could tolerate decaf because I would love to have that as a treat now and then, but it makes me just as jittery as like, almost like coffee.

So if you tolerate it, then it's a lovely kind of stopgap. option. So you don't think that's a good way. There's like been a bunch of studies too about the benefits of coffee and I don't think they're largely due to caffeine. I think they're due to other parts of the pain. Totally. Totally. I think decaf coffee is like a good way to get those benefits. No, because I think the benefits are offset by some of the cost of the decaffinating process. So yeah, if decaf were like something that grew on trees, then like it'd probably have most of the benefits of coffee without the downsides. But yeah, I think coffee not an inherently bad substance, magnesium, antioxidants, like seems to be associated with decreased rates of

type 2 diabetes and Parkinson's and suicide, but I would say I think that the research isn't perfect. I have always wondered, because they'll say someone who drinks six or more cups a day has like a 30% decrease in type 2 diabetes. To me, I don't necessarily think we should all go start drinking six cups of coffee a day. I think genetically the person who can tolerate and enjoys six cups of coffee a day might have other linked genes that are going to make them never be the person that gets type 2 diabetes. These are so tricky. They're so tricky. So you still always have to listen to your body. Like the research is just never necessarily. generalizable to your body.

Yeah. And recognize that there's like lobbies and biases. Like we have so much research to say that coffee is beneficial and booze is beneficial. And, you know, like, honestly, the people that are researching have skin in the game. You know, they want their substance. It's always worth scrolling down to the bottom of a study to see who. Where's the money? Yeah.

And then also just like how much into booze are the people doing the study, you know, everyone just like the inherent. I actually think it's interesting for you to say that as a, doctor and a person who went to medical school to recognize that the people doing the studies, doing the research, and doing your treatment all have their own inherent biases and their own stories and all of that. I think like just so many psychiatrists are themselves hooked on benzodiazepines, and I sometimes worry that part of the reason they dole them out like candy is to normalize their own addiction. So I just worry that, yeah, I just think we all kind of have to be our own

advocate and you can't really trust anything. And we're at a moment right now where we worship at the altar of science and medicine. And we don't really question that ivory tower. And I think like it is such a questionable ivory tower. Our evidence, the idea of evidence based medicine, a beautiful idea, right? It's refuting an old white guy arguing by assertion and just being like, oh, I know what's best. And it's like, no, let's actually study this and find out the truth. Truth, I'm always in favor of truth. But truth is going to be infinitely nuanced and variable person to person, moment to moment, substance the substance. And right now our evidence, which is like the best we've got is so systemically biased by who funds the studies, what gets studied, what lends itself to the nature

of a trial. And the fact, like, even a lot of studies are done on men and have been done on men forever and forever. And so it's like, okay, well, that's how it affects a man's body, which has a completely different set of hormones and a woman's body. Okay, so are you snacking between breakfast and lunch? Oh, yeah. Like a 11 zies is a beautiful part of the day, right? And I think things like fruit, nuts, dark chocolate. I will have like bone broth. I will have like when I'm playing around the dairy, I'll have yogurt in those moments. Like something that's giving you some nutritional benefit and not getting you out of balance. Okay. And for lunch dinner, what sort of our ideal anti-anxiety data and a plate vibe? So lunch dinner can look similar. The way I think that it's,

the most important factor here is eating real food and ideally home-cooked real food. And that is really difficult. So, because the trouble is anytime we're exchanging money for food, like all the incentives are wrong in terms of what they're handing us, they're going to be using the shelf, stable, delicious, cheap, industrially processed conola oils, and all of that is going to be really inflammatory, which goes way back to something I wanted to add about hormone imbalance, which is like sometimes it's just inflammation, and that's what's getting our hormones imbalance. Like, industrially processed vegetable oils play a massive factor in polycystic ovary syndrome, in my opinion. So, which like pretty much anything you're eating out is like I'd say probably 95% of it's cooked in canola oil. Would you agree?

Like if you and I had a restaurant, we'd end up doing the same thing. No, we wouldn't. Well, we wouldn't have a restaurant for this reason. Because we're like, we only want to cook with integrity and use healthy, real cooking, you know, fats. And then that's actually not financially viable for a restaurant. So they're using canola oil. So just like be informed that if you want to pay somebody else to make your food, they're using canola oil. Unless it's like hearth. And so I think. think that that's why I know Marco Canora, the chef of hearth, because for my birthday dinner one year of Vimel went around emailing all these different chefs of restaurants and being like, what cooking fat do you use?

Really? And only Harth responded being, it was Marco emailing back, the chef at Harth, and he was like, oh, we think very carefully about what cooking fats we use and Fimmel's like sold reservation. That's amazing. That's in New York's East Village. So if anybody wants to go. But he also is, he started Brodo and that ships nationally now. That's bone broth with integrity.

But so basically, I think that ideally you have some way of cooking real food at home. The way I make that realistic in my home, there's a couple of phases to my life. When we used to have time, more time, we batch cooked on Sundays. We acquire our food on Saturdays, grocery store, farmers market, Instacart, whatever. And then on Sundays, we would spend two or three hours in the kitchen cooking. And then, as we call it, like tupping everything up. So like putting things in glass, Pyrex containers. and then that was our lunch ready to go.

That was our dinner ready to go. And then we got even busier since having a kid. And now we outsource aspects of the cooking process. So for a while, we had a task rabbit come by for like an hour or two a week on Sunday nights. And she would help us chop. So then when we cooked, it felt so quick and so easy. And we felt like emerald. And we're just like throw the already chopped onion in the pan.

And that was great. And then we've gotten even more decadent at this point. And so now we actually, we have a nanny, which is like a major checker privilege moment. But my daughter's in school some hours of the day. So we pay her for that time and she cooks for us. And that's how we at this point make it all work. So she cooks homemade food for us. It's in Tupperware.

And we pull that out and put it into the microwave. Yes, the microwave because realistic. And to me, I think the microwave probably isn't ideal. but I think microwave home-cooked food is better than take-out, which is what I'd have to do because we're not going to cook fresh every meal. And God bless if somebody can do that, but we can't do that. So, and what we're eating, it varies, but it's things like lentil soup and kittity and beef stew and sauteed greens and roasted sweet potatoes and mashed potatoes and carrots and all that stuff.

You know, it's basically like what's seasonal, what's available, and what is my daughter willing to eat? And then we cook that up and keep it in the fridge and then pull it out and eat it when our blood sugar is crashing. Do you think that people with anxiety should be like universally gluten-free, universally dairy-free? Every day I show up to work with one goal and one goal only, which is, Ellen, today, do not tell all your patients to go gluten-free. I don't want to be a broken record and a one-trick pony. And then I can't freaking help it because every day I show up at the office and I'm like, today will be the day. I don't tell someone to go gluten-free. And then I'll meet a new patient and they're like,

hi, I'm here to treat my anxiety. My mom had celiac. My aunt has Hashimoto's. I can't poop for the last six years of my life. I have this kind of acne and this kind of rash and eczema and anxiety. And it's like, God damn it. And I have to tell them to go gluten free. So I don't know.

There are definitely people in this world who can eat gluten. There's definitely places in this world where gluten isn't so problematic. But in the United States, if you are physically and in terms of mental health experiencing any degree of imbalance, it's a decent chance that our conventional American shitty-ass gluten is playing some role in your symptoms. It doesn't really hurt. It hurts a little bit, but it doesn't really hurt to give yourself four to six weeks,

completely gluten-free, just to know, just arm yourself with that information. Do you start pooping? Does your acne go away? Are you no longer anxious? Or less end at least. Or less at least. And then you have that information and you do with that what you will with your life because there are tradeoffs.

There are always tradeoffs. There's pizza and quassants and then there's not feeling anxious. Oh, you say quissants the fancy way. Do I? Yeah. I feel like I sound like ques sandwich. Is there anything else that, what's your thoughts on dairy in general? Dairy, it's more genetic and individual.

So I don't think dairy is inherently bad, has plenty of nutrition. It's just a big if, whether we're not. not you tolerate it. So some people more like if you have that Northern European kind of gene line, maybe you're more likely to tolerate it. If you're like East Asian, maybe you're less likely to tolerate it. But I think that dairy itself has a spectrum and ways to recognize whether or not you tolerate it are good to know. So because it's not just it gives you gas and diarrhea. Some people have a real like lactose intolerance, but a lot of us have more of a casein intolerance. So it's more of a downstream effect. Like for me, I will break out if I have dairy. For some of

of my patients, they get a lot of mucus and phlegs if they have dairy, like chronic sinus infections, ear infections as a kid, things like that. So you just have to get honest with yourself if you don't tolerate it. If you do, just be aware of the spectrum. Like, at the worst end of the spectrum would be a glass of conventional skin milk. And at the best end of the spectrum would be like a full fat fermented farmer's market kifir made with love under a waxing moon and, you know, everything in between. I had the three glasses of skin milk every day as a child. Me too, right? Like hormone-filled, yeah. In my Honeybunches of Oats, I thought I was nailing life.

My mom thought. She was like, oh, you're getting all your calcium needs. I pooped once a week. I liked it. That was my reading time. You know, because I was in there for like three hours. My private time for reading. Is there anything else that universe, so you're like, if you have anxiety,

everybody should at least try being gluten-free for four to six weeks just to see it. And canola oil universally should be off the table, particularly if you have anxiety. Is there anything else? that you think should be like worth attempting to eliminate? Eliminate. I mean, we talked about caffeine. Let's talk for, let's piss people off with alcohol for a moment. I don't make any friends with this one. We're not here to make friends. But you also don't, you don't, like, you know I still drink and you are my friends. You know what I mean? Like, you can arm somebody with the information and then be accepting of the choices that they make.

There's no judgment. Yes. There's never judgment. We talked about this earlier. Like, when I'm president, The default setting for toilet seats in women's restrooms is up. I can explain why if we need to get into it. There's a squatty potty at every toilet. What was the other thing? And then like guilt and shame and judgment will be abolished. The government is listening through your Alexa devices. And if they pick up on a shame vibe, it zaps you and says, nope, we're not feeling that.

And it gives you like some affirmative self-talk, I think. Yes. Your all-female government is telling you you're not allowed to feel shame right now. So there's no judgment ever, ever, ever, ever. But alcohol, I'm just like really embracing this sober, curious, hip, youthful movement right now. I am kind of... I feel like you've been waiting for it to happen so you could be like justified and not drink you.

I feel like you're not like, cool. It's happening. I'll embrace it. I feel like you're like, thank God. Everybody's coming around. Well, and the thing is, it's like I'm not sober, right? Like I think at this point now that I'm finally reading my friend Holly Whitaker's book, like a woman, I think I am officially forever more a non-drinker.

but like you've seen me drink whiskey at some point. Yeah. Like I wasn't completely sober. But what I'm realizing is that it doesn't necessarily serve us and we've been really marketed to. We're being sold on it. And the research is more biased than I think we realized. Like for so long we were saying that the blue zones,

the Europeans, the healthy people of the world, drank five ounces of wine a day. And that's why they're not dying of cardiovascular disease. But have you ever tried to drink five ounces of wine a day? It's not a substance that is conducive to moderation. And it's, I think that, I just think that it causes such untold levels of suffering in the world. Like, and not just to the people consuming the substance, but there's concentric circles of people impacted by it around them. And I just like us all to make conscious choices.

And it's not to say no one should ever drink ever. It's just make the choice that's the act of self-love and that we all actually reflect on it. So what if somebody is like, okay, that sounds cool, but the biggest way my anxiety manifests itself is social anxiety. And if I'm hanging out with people, which I want to do to form my community and not be lonely, having a glass of whiner two helps me get there. Totally. Yeah. So let's talk about GABA, the neurotransmittergab so GABA, which is gamma amino butyric acid, to me is the, as much as it is possible to say there's a neurotransmitter correlate to what it means to be anxious. Gaba is the neurotransmitter

that helps us not feel anxious. It helps us feel okay, content. like everything's going to be okay. And things that give us a rush of GABA are the benzodiazepines like clonobin and Xanax and Ativan and Ativan and Valium and alcohol. And this would all be great if it was a good drug. A good drug is like acupuncture, like boosts your serotonin and your GABA and then leaves you better off afterward. Alcohol and the benzos boost your GABA and then drop you lower than you started out.

Basically because we are always a system of homeopoeuvial. stasis because too much GABA makes us so relaxed and so chill that the body starts to think, well, if a leopard ran around the corner, I'd be so chilled out and like so surfer dude mentality that I wouldn't run from the leopard. So it thinks it's not safe to be this relaxed. Let me start to downregulate the GABA receptors in the brain. You do not want to go through life with down regulated GABA receptors because then it just to feel at baseline, just to feel okay, you need to be somehow chugging GABA. You need to be either chugging alcohol or chugging Xanax. And so what you really want to do is protect your receptors and stay at a level of like good enough GABA, but not too good, and not too good through these drugs that lift us so high that then we drop lower. So alcohol, I think, is partly responsible for the reason we have an epidemic of anxiety. I think it plays a role in so many people's chronic anxiety. And it feels like our best friend because it's like treating the GABA deficiency, but only temporarily, and then leaving us worse off and worse off.

And that's accumulative over our lifetime. So if you're struggling with social anxiety, which like, I'm no stranger to this. For me, it's a weird mantra, but here's what works for me, is there's this book called House of God that's about the experience of being a medical resident. And they said, any time you show up at a code, and a code is when, like, a patient in the hospital is potentially dying, like not breathing, their heart's not beating, whatever it is. And you go in and it's chaos and pandemonium and it's stressful, it's high intensity. They say, anytime you show up at a code, first check your own pulse. First take your own pulse.

And to me, for whatever reason, that symbolizes to me, like when I'm going into a situation that makes me anxious where I'm like, okay, people are judging me or I'm not going to be cool enough here. I'm not going to say the right thing or whatever it is. It's a moment when you check in with yourself. And you're kind of just like, you know what? I'm breathing. I'm alive.

I am good enough. all I can ever do is just do my best and take it or leave it world. And I think that like to show up in social situations with more of an attitude of, hey, I'm not being mean, I'm trying to be kind, I'm doing my best. If it pleases you, great. And if it doesn't, great. Okay. You know, and if someone is not kind to you when you're doing your best, that's usually their issue. And you don't really want to keep barking up that tree anyway. So I think social anxiety, it's better healed through self-love practices and just recognizing all you can ever do is do your best. Sometimes it'll work. Sometimes it won't. Five minutes ago, I was an asshole. You keep learning.

You keep growing. But you don't need to feel like the most charming, perfect version of yourself. You don't need to numb out from the weird toxic narcissist vibes around you. You don't need to use any kind of substance to bandate this experience. You can be in it and it can be uncomfortable and that's okay. All we can do is do our best. Okay. What about the other often use case forings? or for alcohol, which is I've had a really hard day. I'm coming home. And I need something to sort of set the boundary between like I'm at home, I'm relaxing. I can't just drop into that state of relaxation.

Yeah. Yeah. So I think twofold. One is that like to build other rituals that help you decompress at the end of the day. And that can be a range of things. It can be a cup of herbal tea. And if that sounds too eye-rolled, someone who's like used to having a glass of chardonnay, it's, you know,

then even smoking a joint is like, I think, a less problematic substance. habit than alcohol. But I think that it can be... Does it not rob your gabba in the same way? It doesn't rob your gabba in the same way. It can have other issues. It's a longer conversation, plenty of nuance of its own. But I think overall it's a more benign substance.

And then, or it can be like you play cards or you take a bath or you do some kind of water ritual or that's when you do a yoga nidra or that's when you even like watch a certain show. Like it can be these things that aren't like, you know, exalted. as like good self-care. But like anything that just marks this at the end of the day, I'm decompressing. I think the best is actually just to have somebody who's a generous good listener and you talk.

But something that marks the end of the day, you just build up other rituals. And then I think that the other aspect of this is going back to what we talked about. Like Holly Whitaker in her book talks about it so well. It's like the real key to her sobriety has been building a life that she doesn't need to escape from. So if at the end of the day, it doesn't have to feel like, God, that was so, awful. I need to treat myself. I need to calm my nerves. Like, could you imagine if at the end of the day, your nerves were already calm? I've been feeling, like, that's, I said that when I was coming

over here, like, I feel so good in my life right now. And I, the interesting thing for me has been almost that, like, I felt like I had to put myself in a state of stress. And I would tell myself because I couldn't turn off enough to relax. And I think that was such a false narrative because I can. And I just wasn't giving myself this. I always, I was like, oh, I always, even when I'm trying and relax. I feel like I should be doing something or I should feel like I should be pushing my career forward in some way or doing something productive. But that's not true. I like enjoy relaxing now just because I feel like I'm in a good place. I'm not trying to like run away from the life that I'm living. And it's like it's it's sort of that like walk out of the prison that

you're not even, you know, locked up in with certain jobs and certain just choices we think we have to make like all the shoulds, dropping the shoulds and and sort of playing a little Moana moment of like what is the little voice inside you telling you to do and honoring that. But also like everything else we talked about vis-a-vis anxiety, caffeine and blood sugar and starting the day with a good breakfast and maybe a little meditation practice, getting enough sleep the night before. All those things secretly actually build up towards when you get home at 7 p.m., you don't need a drink. It's interesting how it works that way. But like whether or not you need a drink at 7 p.m. starts the night before at 10.30 p.m. if you're getting in bed. And so like everything we do, it's informative.

the nervous system. And our nervous system is always in this balance between sympathetic and parasympathetic. And we live these days with all of these unnecessary stress responses in the body. And some of them are thinking that our jobs are so important and that we have to respond to certain emails. And some of it is just completely preventable blood sugar crashes. And so, and excessive caffeine or sleep deprivation and or the impact social media has on us. So avoiding unnecessary stress responses, keeping your nervous system in more of a neutral to relaxed state means you just don't need that drink at the end of the day. And that's not just about whether or not you have that drink. It starts that morning. It really starts the night

before. You're listening to the Healthier Together podcast. Okay, I'm going to be totally transparent about something. I completely stocked this sponsor. I've been eating their bars for years and they're my absolute favorite ones on the market and I really wanted to share my love with them with all of you here on the pod. So trust me when I say that I am so excited to welcome Go Macro to the show. I've tried pretty much every bar on the planet. That's sort of like food editor life, you know. And the reason that Go Macro is always my go-to is because it's the only one that actually fills me up. I love taking them when I travel or go for a hike or just run out the door without having time to eat, which is happening more and more in my new solo entrepreneur life. My go-to flavor is the peanut butter

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I love me, some free shipping. Use the code healthier together like the name of this podcast and the number 30. Definitely try the new double chocolate peanut butter one and then also try the peanut chocolate chip. They're so good. I also love the oatmeal chocolate chip one. And of course, Zach, in his quest to consume the most coffee on the planet loves the mocha one. So if you're a coffee lover, definitely try that one out. That is go macro.com, healthy together 30. I cannot wait to hear what you think. All right. Let's get back to the episode. Is the GABA thing why some people get what, like I have a friend who calls it the fear, which is when you're hung over and you get really anxious. Is that what that is? Gabba withdrawal. Gabba withdrawal. Yeah. Like,

this is my favorite way to put on a whole new way of viewing our moods is to recognize, like, what false mood are you in in a moment? That's a Julia Ross term. She has a book called the mood cure, and she talks about a true mood and a false mood. Like a real mood is somebody you love passed away or you just got fired or like there's really something that's uneasy and an interpersonal challenge in your life and you're in a mood and that's totally right. Feel those feelings. Cry, do it all. But then we are in so many false moods. your blood sugar is crashing and you're anxious or you're hungover or and you're in like a GABA withdrawal state or you're an intradose withdrawal between your psych meds like so many people in benzos go into

interdose GABA withdrawal in between doses or even on SSRIs you can go into an interdose state like if it's the nadir of your psychopharmacinetics and pharmacokinetics and you're about to take your dose are you waking up in a panic like that could be an intradose withdrawal state or are you drunk or are you excessively caffeinated or are you sleep deprived? And basically to just start to recognize it's not that the world is terrible and that I hate my partner. It's that I'm in a false mood right now. And honestly, just keep a list on the refrigerator. Like, here are the false moods I dip into and identify them. It's kind of the same. When you have a newborn and you have to be like, is it a wet diaper? Are they hungry? Are they tired? Like you have to learn this system of like why fussy? Why is the baby fussy? Why is the grown up fussy?

And just start to think like, okay, I need to address this one. Some of them can be addressed in the moment, like blood sugar and then have your spoonful of coconut oil. And some of them can't be addressed in the moment. Like I'm sleep deprived and I'm irritable all day. So maybe I make a priority of going to bed earlier every night. And then you don't have that irritability source. So we're going to talk about sleep in a second because that was, I think, your last thing. But just for the hungover thing with the scaries, if you do drink and you do get hungover and you do get anxious and you're not going to stop drinking,

Is there something you can do to sort of regulate your GABA in the morning? Well, I think it's probably nice to take anaestateal cysteine. It's probably nice to take activated charcoal. And then it's probably helpful to do like a deep relaxation type of yoga nidra or like progressive muscle relaxation. Something to put your body in a relaxation response. And I do. I'm glad you brought this up because Sunday scaries, I think sometimes are just because the weekend is when you drank more.

then you're in more of a gab of withdrawal Sunday evening, and that's kind of when. Because it's almost like you drink Friday night, you drink Saturday night, your body's like, okay, give me my drink. You're like, oh, it's Sunday night. I'm like settling in for the week. And then your body goes into Gabba withdrawal. We call it Sunday Scaries. I think it also is everything to do with the fact that our jobs are toxic, but it's a perfect storm.

Yeah. Okay. So sleep with sleep the last like outside factor you wanted to talk about? I mean, I could like talk about this for 70,000 hours. So like, yes and no. But it's lost to be named, I think. So let's talk about sleep. I think sleep is really interesting because I think it is such a fine line between what the wellness

world does where they're like, people need to pay attention to their sleep. It's so important. And people getting freaked out about not sleeping enough and then having anxiety about sleep. I love that you bring this up because there's almost like orthorexia around sleep. There really is. I couldn't get a sleep tracker because it would mess me up too much. And I do notice even in myself when I have a patient who's like really particularly struggling with insomnia. I get a little psyched out about sleep, so like I'll absorb some of that anxiety.

But I think overall with sleep, it's like, I think most of us get it now. It's like prioritized sleep. Okay, we get it. Like that's not the problem. And sometimes it's even like the exacerbates. But then it's more about how do you set yourself up to feel appropriately tired at night and sleep through the night. And that's where I think there's all these strategies you can put into practice. And I think light is the most critical one and getting strategic about light in general. So that can be, I almost think of it as like beginner, intermediate, and advanced. And like beginner is like maybe you install flux on your computer, night shift mode on your phone, maybe you get a screen, like a blue blocking screen projector on your phone,

low hanging fruit, no skin off your back. These don't really impact your life negatively. And they just set yourself up for a little bit of a more protected circadian rhythm by preventing some of the blue light exposure after sunset. Intermediate would be maybe you have a dimmer switch installed in a living room. So at the end of the night, you can turn off the full blast lights and then just have the dim light on. Maybe you own amber glasses and you put them on half an hour before bed when you're reading a backlight candle in bed. Maybe I have patients with bipolar illness who put them on at sunset and keep them on for the rest of the night.

And that's how they're managing their bipolar without meds. It's a little more involved. These days they make like trendy looking. None of the actually effective ones I feel like are cute. I feel totally the same. I feel like if you're wearing a cute pair of blue light blocking glasses. They're not working. I am loyal to my UVX ones that cost $8 on Amazon, and they're really sexy.

You live like a construction work. Yeah, like your fly fishing or doing something like metallurgy. So, like, I think the more goofy, the better. And it's like an order of magnitude cheaper than the ones that look cute. Yeah. And then there's like going full Boys to Men video Game of Thrones, just like candles in the evening. In the aftermath of Hurricane Zandi in New York, people that lived Sopo, south of power,

like all of their insomnia woes were healed for a week because they didn't have electricity to distract them, but also to artificially affect their circadian rhythm. That's actually something I tell me. So I had one really bad bout of insomnia, and I never had it before. I got through our whole, we did a sleep class together, my body grain, and I got through all of that with no insomnia. And then I got insomnia like maybe six months later. And I always told myself if that happens again, because I sort of live in fear.

of it was like three days no sleep and I have that in the back of my mind all the time. But I'm like, I could just go camping. And I think that there's really interesting studies about how much just like a few nights camping resets you and you're like pretty much fine. Camping is a total circadian rhythm control alt delete. Yeah. And then the more you can simulate that in your modern life, the better. So candles in your living room, taking an Epsom salt bath by candlelight, bonus points.

Like that's a great thing to do before bed. And then I do think that getting the phone out of the bedroom is like a very critical step in terms of being strategic about light. And then the drama thing. So we get so much anxiety about insomnia and it's a self-fulfilling prophecy. So the way I tell myself and my patients, because CBTI, cognitive behavioral therapy for insomnia as a whole involved system around this, but so much of what they use to get people to sort of like lose the association of tossing and turning, with their bed are things that to me like nails on the chalkboard in terms of the ways I like to protect people's sleep because it's like get out of your bed and go watch TV in the other room.

It's like, no, because like I still believe in light and that there's like an ancestral truth to the circadian rhythm. And so I prefer to tell my patients, it's total counter to the orthodoxy of CBTI. But if someone is tossing and turning and having anxiety about insomnia, I basically tell people to lie with your eyes closed in the dark. your bed and rest and remind yourself, like, you drop the drama about it and you remind yourself if I did nothing but lie here with my eyes closed in the dark all night, not stressing about it, I would be somewhat rested tomorrow. And then I would be sufficiently tired that I'm setting myself

to more likely sleep tomorrow. So I think it's the drama about it that ends up being what snowballs. And so if you can drop the drama and just trust that this is restful to a certain extent, it can be really healing. I also like to tell myself that, like, I've had, great days where I haven't slept the night before and it's been fine, you know? There's even that like sleep restriction therapy for depression. So sometimes I tell myself that. Really? What's that? Like, you know, they'll restrict someone's sleep and then they have a boost in their mood the next day. It's like almost a hormesis thing. It's like your body, you know, kind of compensates for it. Oh, that's interesting. Yeah, it's not all bad. I also think, I mean,

while we're going against the orthodoxy, like all these wearables that tell you about your sleep, they're so hot right now. I have so many patients who have so many patients who've so. aware by them. The thing is, I think that there can be some merit to tracking, like, when I do this behavior, it impacts my sleep this way. I love when people see, like, oh, when I drink, my sleep is worse. But I think that there is a potential for a nocebo effect from it, which is that you wear a wearable, and in the morning you wake up and you think, maybe I sleep good, I feel okay. And then your wearable tells you you didn't sleep well. And then you're like, oh, now I'm going to have a lousy day. Yeah, I totally think that's true. And I think that, like, sometimes I

I don't love the quantum light. Or you start to like think that like, oh, if I had this this morning, if I work out, I had a thing for a while where it's like, oh, if I don't work out today, I won't sleep well. And like, it's not true, you know. There's, it's not a one-to-one correlation, I think, with almost, I mean, I couldn't drink a coffee at night or something, but it's not usually a one-to-one correlation. And like all these ways that we objectively measure ourselves, like to me, it's just us being in our masculine and not.

And like, even, like, we've already have a very dusty atrophied. hotline to our own reading our bodies. And like, I never want to make it any dustier than it already is. Like, the more we can be listening and in tune and, like, the way we check our cervical fluid, like, you want that all in so many ways. Not that you have to wake up every morning, like, check all the gaskets in your body. But just like always moment to moment, you're in a dance with yourself and you're aware. Like, it's a moment where you're just like, time out. Like, what is my body telling me right now? What do I need? Okay. And it doesn't It's a muscle. Like every time you do it, you're working that muscle.

Exactly. And it makes it that much easier in the future. Exactly. And like all of us, we just like need to shut out the noise of like all the wearables, all the objective testing, all the blood work, all the everything. And just like, be like, no, I know myself. I hear my body talking. What about CBD for sleep and anxiety generally? I think of it as a, I have not really had that many patients. harmed by it. I've had one or two patients with like kind of like lime or chemical hypersensitivity who haven't done well with it, but most people have found some benefit from it. And some people have found a lot of benefit from it. And within that, there's so many different gradations and

formulations and quality. And so I think like it's worth playing around with, trying a few different ways of administering it. Some people, an ointment works better. Some people like taking a tincture works better. I think it's worth playing around with. For anxiety writ large, I find it more helpful for sleep than for anxiety. But I think with anxiety, I'm just so, like, I think having something to reach for in a moment is a nice temporary measure. But overall, I want people to just be less anxious and not need to reach for something. And I believe it's possible. What about in that moment, I got this question a lot in that moment where you feel like you're sort of spiraling, what can you do in that moment to bring yourself back?

Yeah, the point of no return with anxiety. Or maybe there is a return? Yeah, yeah. I mean, I get that question 100 million times a day, and I still have yet to have a really good answer to it. I think overall I'm like playing the long game with health always. So I would always rather get you to a point where you don't drop to the point of no return than have to recover from it. But I think what I do advise people to do in that moment is like it's get into your body, ground in your body. So it's basically like whether you take child pose or you take mountain pose or you just like sit in a chair and put your hands on your body.

your thighs, but you basically like become this investigative scientist who's just curious about your body. So you're basically like, what do my feet feel like right now? What does, you know, my heart is pounding. That's so interesting. This is how my body responds to a stress response. My breathing is shallow and rapid. That's so interesting. My vision is tunnel vision right now. That's super interesting. Like these are all the ways my body responds to a stress response. This was adaptive if I was in acute stress because I had to run from a leopard. This is maladaptive now because I'm just, living in a life with chronic stress and too much like strong coffee. And I think that you just get curious about your body. I think that I used to say breathing exercises until like the 2000s

patient told me like, Dr. Vorra, that's not helpful in this moment. Like it doesn't help. So I think that breathing exercises work more preventative and they're more prophylactic than they are reactive. I think in the point of no return, you just remind yourself, this is panic. This is a stress response. it's not dangerous. It feels dangerous. All the alarms are screaming in your body that this is dangerous, but you remind yourself you are a healthy person. This is not unsafe. This is just uncomfortable. It's squizzily uncomfortable. And the more you can ground in your body and just remind yourself, like, here's what it feels like to be grounded in my body in this chair, on this floor, and get curious and just start to identify the ways it is a stress response. I also find that

the more I'm not, like, when I feel that wave of panic coming over me and I try to push it away, it makes it so much more powerful and so much worse. And if I can just be like, okay, like I'm going to feel anxious and then I will feel fine. And it's almost like that it always comes in waves. It feels so much better. And I think you can really push yourself into a full bone panic attack by being like, I'm feeling anxious. What could I do?

What can I take? How can I push this away? Yeah. There's the Dare book about anxiety, which is basically this. It's kind of teaching us how to not resist the anxiety. I do think that it's very true that like what we resist persists and anxiety is definitely one of these things. So the more we try to strong arm it, it sort of doubles in strength. And in some ways, it even is built on a foundation of us, like not feeling comfortable,

flowing with our feelings and feeling our feelings. So it's almost like the body was whispering, then talking, and we didn't hear it. We ignored it. And then the body's screaming in the form of panic. So I think sometimes the more we can just have a practice of like always listening to our body and not betraying ourselves. Like I think that sometimes panic is like, you've been in a toxic job or you've been in a toxic relationship or you're not hearing your inner Moana voice on some topic and like, do you have a toddler? Because you keep practicing references. Does not everyone watch Moana on the daily? Yeah, have a toddler. I think she's now technically almost a kid. I call her a baby though. It's problematic. What is though the line between

Zach and I talk about this when we fight sometimes because I'm like, you should just accept all. of me with my anxiety and love all the parts of me. And then he's like, but aren't you trying to assuage your own anxiety? Like, why do I have to love the parts that you're actively working on? So what's the line between taking control of your health and taking corrective measures and like being like, I accept and flow with as part of me? I love this question. So I think that for ourselves and what we demand from our partners, it's a total balance. You have to like integrate and hold the two contradictory things at the same time. It's total unconditional love and acceptance. And at the same time, like, how do I help you grow

to be the best version of yourself? And anxiety, I think it's one of these things where I also want us to treat the anxiety and embrace the anxiety at the same time. It's like, if I made a patient, I'm like, let's fix your blood sugar and your hormones, end your caffeine, and your gluten, and your gut, and like, and your sleep, and your exercise, which we can talk about too, so that you're feeling less anxious. And then when we've done everything right, if there's still anxiety, I'm like, hallelujah. let's listen to that anxiety. Like, that is your truth. And sometimes I think anxiety serves us. It is a way that our bodies are talking to ourselves. It's communicating to us. It's telling us, like, okay, climate change is not cool. Okay, like something about this job is not cool.

Like, it's waking us up, you know, and it's the people that feel most anxious in many ways are canaries in the coal mine. There are sensitives. There are artists. They're the people that are feeling when things are not right. They have interesting research about like primates where it's like the anxious primate makes the whole tribe survive better, right? Yeah, and that's sort of the highly sensitive person concept, right, that like a few people in every group had a heightened nervous system. Do you subscribe to that notion? Completely, yeah.

And I think that it's like, I mean, I think it's harder to be a woman than a man, right? And I finally made peace with this and stopped being a self-loathing misogynist. When Gormuk, the Kundalini woman, said to me when I was pregnant with a girl, she said, ah, girl, it's harder, but it's a higher. calling. And I think like to be an anxious person, it's harder. It's a really high calling. It's a duty. And I think that the more we can actually embrace it and the more maybe our society can help hold our anxious folks rather than just make them more anxious, but like hold them and cherish and and show them that it's precious, that their sensitivity is a gift for all of us. So it's like do away with

the unnecessary anxiety from the caffeine, et cetera. But then the remaining anxiety is like a very precious resource and we want to listen to it and honor it. I think a lot of anxiety, like anything, it's like a lesson that it doesn't stop hitting us until we've learned it. So it's like if your body's telling you something is not right in your life, it's going to keep shouting at you about it until something shifts. What do you think about those external things though, like coronavirus or climate change or Ebola, like the sort of things you can't control that do stoke your anxiety? Or should you stick your head in the sand and not listen to those things? I think they're really, those are such different things. So some of them are like, so take climate change. Like,

we need our sensitives and our artists to tell us like, hey, everybody, wake the fuck up. Yeah. We cannot keep doing what we're doing. You have to change behavior. Something like Ebola and coronavirus, I think it's much more that we live in a world right now that has figured out that if they sell us fear, we will buy what they're selling us. So like I think from news networks to pharmaceutical companies, like if they sell us fear, we will show up and swipe our credit card. And I think that a lot of people that are prone to anxiety, it's just a mismatch because we live in a world that's constantly around every corner trying to sell us fear, just to make money. Even like wellness websites are like, here's the things that are wrong with you and then you get add dollars.

So the more you just opt out, like so much rebellion, like opt out, opt out, opt out, the things that are making you anxious, but like leave the remaining really truthy truths in your life. So like if you're like, no, I'm pretty sure no one's trying to sell me fear on climate change. It's just something I feel in my bones. Go for it. But if you tune into the news network and it's like sensational news story of today, you know, like just turn it off and read something positive and life affirming. And I do tend to overall subscribe to the fact that in our dynamic and intropic and crazy world, like we are barreling through space and like things are getting more chaotic and better like I think I do think that like the arc of history bends towards justice and so I think that um like so much is wrong all the time in

the world um but I think that like you can allow a certain amount of things not being perfect like we have to there is no other way and so it's more just like being able to hold that and still feel some sense of trust and surrender in this journey. That's lovely. I want to do that more. I'm bad at it. I'll be scrolling through news, which I'm just doing to kill time, which I shouldn't be doing in the first place.

I hate the phrase like killing time because my biggest fears are existential ones based around the fact that I want to live my best life. And then when I hear myself say killing time, I'm just like, what are you doing? That's the only thing you don't want to kill. But then I'll see like an article about coronavirus. And I'll be like, don't click it. like don't, or a plane crash. And I'll be like, don't click, don't click, don't click.

And I'll click it. And I'm just like, why do I do this to myself? We're in these masochistic codependent relationships with the news networks, with certain Instagram accounts. Like, they're like, let me grip your attention with fear of death. And we're like, oh, sign me up because I know I will be addicted to that feeling. And like, just unsubscribe. I know.

I tell myself it'll make me, like, there'll be some backed in there that'll make me feel better. And then they're like nervous. No, it's only selling us the fear. And step back and just look at the pattern. Right. Like every few months, like the news networks are trying to freak us out about something happening somewhere on the globe that might theoretically impact you and like just kind of see it for what it is. Like they are trying to get people to tune in. Yeah. And I mean, I think the same with politics in a lot of ways. It's like most, I think everybody should be politically engaged. Everybody should vote. But 99% at like my mother-in-law watches the news so much and she gets so anxious about it. And I'm like, nothing that they're saying. Monday, Tuesday, Wednesday, Thursday, Friday is going to change anything for you.

You need to go vote when you can go vote. But, like, you know, I think it's problematic. There's, like, a forest for the trees or, like, much ado about nothing concept. And I think, I think about the ways my family and my husband's family schedule and coordinate things. And I'm not saying one is right or wrong, but, like, in my family, you'll be like, hey, dad, do you want to have dinner on, like, June 25th, 2025? He's like, it's in the calendar.

did you don't need another text message he'll show up right and like my husband's family it's like we have a plan but somehow we still have 15 phone calls between now and like an hour from now when the plan is coordinating and like it's just interesting both are kind of problematic but I think that there is a much ado about nothing and like sometimes we can just step back and like let the noise the noise and data kind of noise like just the ups and downs of the moment to moment just like let that sort itself out and then you step back in when there's some kind of like more meaningful data. It's actually one of my favorite things about not being full-time editorial anymore is that I don't feel like I have to manipulate people's emotions to like meet my own traffic goals anymore.

No, it's true. But like if you read, anything you read, think about the fact that the person who wrote it, if it's online, had traffic goals that they were trying to attain. And they, we knew at the end of the month what triggers we could pull that we could hit our traffic goals if we needed to, like 100%. And yeah. Okay, so you said this is the last thing I want to do before we do some speed round stuff because you have to go be a mom.

You mentioned exercise when we haven't talked about exercise. Yeah. So, like, I'll say something that's, I mean, like, I'm not going to bore anybody with like, you know, you should exercise. It's good for you. But more like to get into the nuance as it pertains to anxiety, I think that with exercise, it's just don't take for granted that like the latest, most hardcore get you skinny exercise is what's going to be most beneficial for you.

And I see a lot of people with anxiety who are like going to SoulCycle or, orange theory or SLT or whatever is the thing of the moment and it puts their body in a stress response and it's exacerbating anxiety not making it better and they're like there's like a balance here for sure but I think that exercise is great it's a wonderful treatment for anxiety it's better than medication but it's not all created equal and you kind of have to know what works for your nervous system so maybe you err on the side of things like yoga Pilates things that are a little gentler on the body. And then you try a run or you try SLT theory and then you just see, is that like making you feel net pot better? Or are you a little more rattled that day? And just

be honest with yourself. I also think, do you think there's something to, I started weightlifting recently and I love it. But it makes me feel more anxious directly after and then it makes me feel calmer later. Do you think there's my, I was asking my dad about this. And he said that he thought maybe there was something to, like, hyping step up and then it calms it down or something like that. Do you think there's any benefit to something like that? Maybe, but my gut says, like, it's risky territory. But, I mean, I think weightlifting can be fantastic, doing it responsibly and carefully and la, blah, blah. But I think that if we're, like, playing around with, like, hype up to calm down afterward, I think that's risky.

That's not a good idea. Okay. So do – there's no, like, universal exercise that you're like, if you're like, if you're have anxiety, this is the best exercise for you. I mean, like, welcome to 10 years ago. Yoga. I don't know. I think yoga's great.

Like, it sort of works on so many levels because of the breathing. You are tricking your nervous system into a relaxation state because there's a two-way street between our breath and our brain. And in, like, if you were truly relaxed in a hammock in the Caribbean, sipping your version, Pena Colada, then you are, your brain is telling your brain, I'm relaxed, and your breath sorry, your brain is telling your body I'm relaxed and your breath is slow and deep and diaphragmatic. But most of the time we're running around and our brain is telling our body, I'm stressed, I'm anxious, and our breath is shallow and rapid. And so you can hack this system.

You can short circuit by just breathing slow, relaxed, diaphragmatic, deep breaths and it tells your stupid brain that you're relaxed, whether or not you are. So if you spend 45 minutes or 90 minutes in a yoga class breathing in that way, you have convinced your silly gullible brain that you're relaxed. And it's just as good as the real thing. Although I do think you need to do the breathing. I think I myself have been guilty of going to yoga class and be like, I'm going to get such a good workout and not even paying attention to the breathing component of it.

Like yoga's the best gateway drug because everybody goes for the vanity of it and then like kind of gets into the real aspect of it. And like eventually you're not even doing asana. You're just like a whole child pose the whole time. But I think that there's also the truth of like. like holding a pose that's uncomfortable and being faced with that edge of, I do not like this. I want to get out of this pose.

Fuck this teacher. Fuck this class. Fuck yoga. I hate all this. And then being like, oh, that's kind of the point is to like see that, like, come up against that edge and myself. And can I tolerate it? And can I breathe through it?

And can I stay serene? And can I experience self-efficacy of see myself like endure something I didn't think I could endure? And I think that you have that experience on the mat and a yoga class. And you take that with you out into the world. And then you're in a meeting and your boss is like, blah, blah, blah, blah, blah. And you're like, wait a second, like go back to being in Warrior 2. And it's like, you know, someone with, you know, that was basically a similar experience.

But I breathed and I stay serene and I managed to get through it and I can do it in this situation too. Interesting. Okay. And then the other thing before we go speed around is partners in general. Like if you have a partner as anxiety and you don't, is there something you recommend for that? And then also if you have anxiety but you feel like you're struggling to.

communicate what you need to your partner and supporting you, is there ways to deal with that? Let me see if I can answer both. So I think that if you have a partner who's struggling with anxiety, one is like you could be the blood sugar spoonful person. Like my partner does not have anxiety, but he gets angry. He gets hangary less now that I converted him to the dark side of eating meat. Yeah. But I would kind of just have the spoonful of ghee at the ready. And then 5 p.m., I'd be like, oh, here. Got how many fights do you think would be, prevented if every time you started a bicker with your partner, both people just took a spoonful of almond butter and you were like, oh, okay, I guess they don't need to fight now.

I had this model patient who, like, she and her boyfriend would both get hangary and then they just started being like, you know what, Dr. Vora said that this is a false mood, this is hangar, let's both take a butter spoon, take 20 minutes, and then have the fight. And then they'd never fight. It's crazy. It's crazy. And just, you know, you come home from the airport and the taxi and you're jet lagged and you're sleep deprived and you're off a red eye and you're bickering and you're hungry.

And it's just like once in a while, catch yourself and realize, like, I'm not irritated with my partner. I'm just in a false mood. And it can make us more compassionate and empathetic and gentle in the world. But I think if your partner's anxious, you have a responsibility. You know, you have an opportunity to, like, ground them in good communication. Like so much of the time, we just need to feel witnessed. We need to tell our story, feel heard, feel understood. and partners are in such a good position to do that. And so, like, anxiety is sometimes just a knot of tension that needs to be discharged. Like, we lack any cultural system for completing the stress cycle and discharging our stress and talking and hugging and cuddling and kissing and making out and good sex and laughter.

Like, all in exercise and dancing and Whitney Houston and all this is, like, a really good way to discharge stress. And as a partner, you can be like, I see that you. you're in the point of no return. Like, you're in a bundle of stress and anxiety, but I can suggest that we put on Whitney, Houston, and dance. And you can just sort of help somebody discharge their stress lovingly. And the other part of that question was like, if you have anxiety and you, like, want to communicate what your partner can do for you, but you maybe have a hard time, or even feel like they're insensitive to the fact that you have anxiety and they're not good at dealing with you, but you love them in every other way. Yeah. And I feel like I speak to women in particular.

I think like men for the most part are good finding ways of having their needs met in this world. And I think women, it's a whole fraught like just bundle of crazy that like it's so hard for us to identify our needs, feel like we're worthy of having our needs met, advocating for ourselves and asking to have our needs met, actually like effectively getting our needs met even if we feel empowered enough to ask for it. Like it's tough. And so I think that if you're anxious and you're basically saying to your loving and supportive and generous partner like, I think you can make it as specific or as vague as you need. If you know what you need, basically, like I'll come in the door after a hard day at work and I'll be like, hey,

them all, like, I need to feel witnessed. And I'm just be like, I'm going to talk at you and tell you what I need to process right now. So I'll be very specific in asking for what I need. But sometimes I don't know what I need. And there it's like you might show up at a situation and you might say, I'm really sleep deprived. I'm feeling a little fragile right now. Can you just be patient with me? I might not be my best self right now. I might not be seeing things that I'll be proud of later. Like can you kind of tap me lovingly and rein me in? Or can you just like extra compassion?

So I think that sometimes just has to ask for something more broad of like I can feel that I'm not my best self right now. Caviot. You know, you basically just like put out a warning. And sometimes you just say like, I think I know what I need. And can you support me in that? And what if you feel like you're saying that and you feel like they're not? gulp. So I think that relationships are like the toughest, right? Like it's hard, hard work and it's so

rarely perfect. And so like you want to get into the nitty gritty, like nonviolent communication of it. Like if you're coming against resistance, you're you're stuck in some kind of rut with your partner where you're not feeling like you're getting your needs met. Like I think there's a lot around like seek first to understand and then be understood. So it's like get at like, in what ways are your needs not being met right now? And what ways is this generating resentment for you? So you just like open, open, open up like, you know, and you advocate. You basically say like, you know, I feel right now like I have a need that I want it to

be met. You're not obligated to meet my needs. Like nobody ever is. And that is like one way to get to badness, right? So you never obligate your partner to meet your needs, but you're giving them an opportunity to enrich your life. And usually people actually want to take that. This is very nonviolent communication language.

So it's like, I want to give you an opportunity. to help me meet my need. And if you don't want to take it, like, I kind of want to understand better. Are you not feeling like some of your needs are being met here? How can I understand that better? How can I have more compassion, more empathy for your experience here? Here's my understanding of your experience. Can you clarify this from me and correct me? And then maybe you take your needs elsewhere. And I don't mean to say like open relationship, but it's like, you know, it shouldn't all fall in one person. Like, sometimes you need a circle of sisterhood around you. Like, that's who's going to meet your need.

And, you know, I think it's more just like being a matchmaker in your own life of like, I have a need. And I want it to be met by somebody in my life. And it might not all fall on one person. Okay. Let's do a speed round. And I'm going to say like something. And then you will say your thoughts on it for anxiety. And I'd like you to consider the fact that we have limited time and limited money.

So we already said CBD may be worth trying. Magnusium definitely worth trying. both in the form of Epson Bath and in pills. Blood sugar balance, definitely worth trying. Maybe eliminating alcohol and caffeine worth trying. What about L-thianine? Okay. So we just saved you a lot of money because you cut out your fancy coffee drinks and your alcohol and magnesium is dirt cheap.

So L-thianine, I think, of the different, like, to me, that's like the second tier of what I reach for after magnesium. I think it's among the better ones. Okay. Ashwaganda. More complicated. I think that adaptogens are right now being put in the tap water in Venice Beach, and I think like it's riskier than that.

It's not safe for everybody. It's not right for all kind of constitutions. And so it might be worth trying if you can do a clean experiment and really see how your body tolerates it. See how it affects your hormones. See how it affects your energy in your sleep. Nothing makes me more nervous than influencers who make,

I mean, we've talked about this, I think. They're tonics in the morning with like 7. different kinds of adaptogens in it. And I'm like, oh, here, if you want to make it at home, just blend. And I'm just like, please let a Chinese medicine doctor prescribe you these. Like, it's just the real power. I think that they are powerful. And that's why it makes me nervous that you're just willy-nilly making your own concoction blend.

Just because something's natural does not mean it's safe for everybody. Yeah. Yeah. Or like the people of Moon Juice are doing it for you. And I'm just like, well, okay. Thoughts on that. Okay. What about, did I say Passion Flower?

You didn't. Passion flour to me, like, so there's this tier of like Valerian root and Passion Flower and flower essences. And I think a lot of them's relatively benign, kind of, if you really still feel like you want something to reach for, they're better than like Cavanies and they're better than Benzos. But I still always feel like we can get you there without these things. And I think there is merit to just taking less supplements. Like I think that there's something energetic to the feeling of swallowing back a bunch of pills and feeling. like a patient. And so I like people to kind of get where they need to get generally with food and lifestyle changes before supplements. But things like Passion Flower Valerian root, there's evidence behind it. They can be helpful. So it's not like a, I wouldn't say no, but I feel like we can get you there with magnesium and getting the phone out of the bedroom and yoga. Probiotics. More complicated. So I'm no fun. So I think that like, yeah, all of our guts are decimated by modern life and antibiotics and antibiotic residue and our dairy and our chicken and our tap water and sugar and alcohol and chronic stress and birth control and everything that we do that affects our guts

anti acids. But I think that probiotics, like it is such a nascent science and I think that so many people run around with undiagnosed SIBO or small intestinal bacterial overgrowth. So sometimes a probiotic makes things worse before it makes it better and people just feel kind of like bloated and they have these methanogenic farts, and they basically just feel like they've aggravated the situation because they have. So I think that sometimes it's worth titrating up more slowly with beneficial bacteria in the form of fermented foods. So like a gut shot of sauerkraut juice or sauerkraut or beet kivas or apple cider vinegar, something where you can start small, like a very tiny amount and see how your body assimilates it. And then you can increase it.

Okay. What about mushrooms? Like rashi is often cited for... You knew what I was. Not like, take it out. Well, I think we should briefly touch on that as well, though, but I'm going to try to let you like go be mom. I'm less informed about like all of the different mushrooms, but I do think like mushrooms, like fungi as a species, like as a kingdom, I think it is here to help us. I think they are kind of these intelligent organisms that communicate. I'm getting pretty out there right now. But I think that a lot of them are here in a medicinal capacity.

A lot of them are here in an environmental saving. capacity. So I think it is okay to play around with mushrooms. But the witch and the what and is it a lines main or ratio or chaga, I don't even know. Okay. Just really briefly, because I'm going to have you back on and we'll do sort of your whole story outside of Ask the doctor, but briefly psychedelics, ayahuasca, that type of experience. Yeah. So basically, totally not for all people, all settings. That's kind of the whole point of it. But I think that I'm very excited that the research is in such a renaissance right now and that we seem to actually be for the first time ever like the FDA is doing the right thing and heading towards medicine that is it's just a

paradigm shift from what we have what we have right now is lousy and the field of mental health is in crisis and we do need a totally different approach and I think psychedelics are such a promising new line of treatment they work in like a very like talk about like adaptogens on steroids like they work they're anti-inflammatory, they increase BDNF or brain-derived neurotrophic factor. They help increase neurogenesis and neuroplasticity, which the translation of that is basically like our brains can grow and change and adapt. And if you're stuck in an entrenched pattern of OCD or rumination or dealing with trauma or substance abuse, like it can really blow things open and help things shift and change. I love that. And not to mention the fact that part of the reason, this is the part that the

pharmaceutical industry will, like, not get, and that's beautiful, is that they don't just work in a neurochemical way. They also work in terms of like a mystical experience. And the pharmaceutical industry will want to isolate out the part of psychedelics that like changes the brain and they'll want to get rid of the messy part, which is the trip. And the trip can be beautiful and it can be tough. And it's a feature not a bug. So basically like the more of the mystical experience, the more the more you have a confrontation with what you need to work through, with what are the blockages, with what you're not totally hearing from your unconscious, like I think that that is a major part of the medicine and the reason it works. So in a safe setting, if you're the right candidate for it,

which is not, I think not people with bipolar, not people with psychosis or schizophrenia. I think not people in acute crisis. So a safe facilitated setting, if you're an appropriate candidate for it, I think it's beautiful medicine and it's not easy medicine. That's part of what I love about. it. I think that, um, I don't think that, um, like, I think that we have big profound shifts by having big profound experiences. Talk therapy. And I'm thinking like the, you pay $150 to go see a therapist every week. Do you think that's worth it? Sometimes. So, um, it's all alchemy and chemistry. And like, if you just actually need to feel heard and held and reparented by somebody who's awesome and doesn't suck. And if you had a really like, sort of not meeting all your needs, and like, you just

sort of not meeting all your needs childhood kind of situation. Like I think it can be really beautiful to just be held and listen to and someone doing generous listening who really gets you and knows your story and is there consistent and reliable week after week. I think there are real insights to be gotten from talk therapy. I think that here's more of my controversial views. I think that with trauma, it can be retramatizing and problematic to just talk about trauma. So that's where you definitely want to do trauma-specific therapy, like with a somatic experiencing therapist or an EMDR therapist, or just take your trauma therapy out of the therapy setting and do energy work like craniosacral or rakey or acupuncture, just doing something more

nonverbal and more energetic in the body. And then I have an increasingly controversial view about CBT. CBT is sort of like the gold standard of this is the evidence-based kind of therapy. This works. And it's a little bit untouchable. But I feel like it's a little bit misogynistic. And this is like something I'm still working out. This is like a rough draft thought. But it sort of makes it's founded on a principle of like your feelings are wrong and irrational. And like you need to come over here to the rational side.

And I guess I kind of just feel like I'm a feelings embracer. I think that your feelings are sometimes false moods and sometimes excessive and sometimes a stuck pattern. but sometimes they're very valid and I don't really ever want to tell anybody. Like I just never want to invalidate someone's feelings. And so I think that there's maybe some room for us to evolve to like CBT plus, which is like hear new ways to challenge your automatic thoughts and here are ways to get insights. Which I think is some good CB. I'd be curious to hear you have a conversation with my dad about this.

I know you guys have talked about this stuff a little bit. But because he embraces. I've never, like, watched him work. But I know that he's very emotional and he very much embraces. He's a big fan of, like, telling people that depression can be a good feeling and that they should, like, lean into that and stuff like that. So any, like, listener of Healthier Together probably suspects that our brilliant Liz Moody comes from a brilliant dad. And, like, I think a really enlightened practitioner can do right by any treatment modality. So I've had a few moments of, like, good conversation with your dad.

And I know that, like, CBD wielded by somebody with that level of, like, judicious sensitivity, right? Like, he's doing it right. I just had to put that in here because my dad will listen and he's, like, in love with you in a very paternal way. And I feel like he'd be really sad if he thought that you... Oh, it's mutual. No, yeah, I think that I want to sort of, like, fight for, like, I just don't want us to let anything go unquestioned. and I think CBT sometimes goes unquestioned, but I just knowing your dad, like, he doesn't let things go in questions. Like, he's practicing that with a lot of grace and appreciation for nuance.

And you mentioned acupuncture. Is that worth it to you for anxiety of the treatment? Yep. I love acupuncture. I give my patient's acupuncture. It's like this little sneaky trick I do, which helps people drop into therapy and, like, things flow more readily. But it's a really wonderful way to put the body in a relax relaxation response. It's a really great way to move the energy where there's blockage, where there's anything stuck. And I just love taking things out of the verbal blah, blah, blah, and putting it into like let the body shift and heal itself. And so I think acupuncture is fantastic. What about tapping, which is, I think, related to that. Yeah. EFT, emotional freedom technique or tapping is a really nice way for you for free at home to just like watch a YouTube video and

give yourself a little bit of acupressure on some acupuncture points while reciting positive affirmations and like there's just like only I feel like it's only a good thing to give yourself that kind of acupressure and recite positive affirmations so I love it as an option. Hypnosis? Hypnosis is something that I've only been a little bit trained in. I think that it can be great for whatever reason it's not like the most in vogue right now and it's not top of mine for me, but I think a good practitioner can do amazing work with hypnosis. Is there any other like kind of fast thing that I didn't say that it'd be what you'd like want to render an opinion on? Um, no. Okay.

Is there anything that you would want to say to somebody who is out there listening and has anxiety? Yeah. So I think that it's like a total paradigm shift from the way we've been taught what mental health is. So it's not like this is genetic, this is hereditary, it's a chemical imbalance. You're broken. You need a doctor with a prescription pad and a medication to correct the chemical imbalance and you take that forever. I think it's an old story. I think that was in large part marketing. And I think that there is, like, it's a much more hopeful understanding of mental health. Basically, yeah, you might be prone to anxiety, and that might be how you're manifesting symptoms right now. But a large part of it is physiologic and preventable, blood sugar, caffeine, alcohol, sleep, exercise, so on and so forth. And then a large part of it is something that shouldn't be resisted, but should actually be embraced and listened to. And it's what makes you, like, honestly, in certain ways, like, I don't like to overstate it, but it's, like, a super,

It's like a special thing. It's a gift. And it doesn't feel like a gift, you know, but it doesn't feel good. But you kind of want to get into more of a dance where you're not resisting it. You're embracing it and honoring it, but also correcting all the unnecessary stress responses. So consider it something that can be changed. You don't need the person with a prescription pad. It's just between you and your basic, fundamental, unsexy, like low-tech life choices on a day-to-day basis. Sometimes it requires some rebellious choices going against the default settings of our society, but you can do it, and a lot of it actually saves money. It doesn't have to be expensive. And then basically the part that remains after you've corrected for that is something essential to you,

and it's part of who you're here to be and what you're here to do. So it's not all bad. I have to ask, though, because it's become very in vogue for people, not even in vogue, but it's just people are trying to destigmatize medication for anxiety, and people are like, I'm doing all the stuff. I'm everything you just said I'm doing, but I still need the pill because of my chemical makeup. What are your thoughts on that? Yeah. So that's a huge topic.

Like we've got Lady Gaga doing that. We've got like all these people doing that. And like overall when I see that, I think yay, awesome. Like more discussion around mental health, less stigma. Like having role models admit that they're bipolar. They struggle with anxiety or depression. Like I think it's all a beautiful thing. It's so well-intentioned.

And I don't fault anybody for not. being like on the cutting 5% edge of like, and we know how to manage this stuff without medication. So that's like a few of us weirdo holistic psychiatrists out there who have cracked the code for like, actually, we can manage depression, anxiety, bipolar, insomnia, ADHD with diet and lifestyle modifications. But it's like an emerging discipline. And so I don't fault Lady Gaga for not knowing that, but I'm hopeful that the conversation goes from we whisper about anxiety at the dinner table to less stigma to lady gaga saying hey this is

me and you know you can do this and take your meds to hey did you know that there are a couple weird psychiatrists who are doing this without medication and it's not to ever shame anybody or devalue the act of taking medication like of course like you're just being a good citizen doing the right thing you went to see the doctor you got help like all that's beautiful it's empowered it's advocating for yourself it's getting your needs met. But I think that like we now have the next frontier, which is like we can do this without meds. You didn't know that when you got put on meds, but now you know. And we can do that.

And it doesn't make it a worse choice to take meds. My issue around meds is not that they're somehow like morally inferior or like the wrong thing to do. It's that we lack informed consent around it. So when you get put on meds, nobody tells you that they don't separate from placebo from mild to moderate depression. no one tells you that they might cause this laundry list of side effects, and certainly no one tells you that it's hell on wheels to get off of them. So that's my issue is that I just want people to know that before they start. And if you know that and it's like I am just, I need something to just get out of bed and exist and survive right now, then like if you're informed and you make that choice from a place of self-love, like, God bless do that. But I just think that like it is epidemic right now, the lack of informed consent around it.

Or like people who are getting prescribed by a general practitioner versus going to a psychie. If somebody ever wants to get on meds, I'm always like at least go see the person who's trained in the things that they're prescribing them. Because they're often just like total, like, trigger-happy pharma jockeys. And so you'll just get put on a more complicated cocktail of meds. But I think that overall, like I just no longer start people on meds because I can get somebody where they need to get without the meds. And I'm so intimately acquainted with the journey of people getting off of psych meds, which is so tough. And I just never want to set someone up for that life path. But I also think that life is so gray area and complex and nuanced.

And like, I'm a holistic psychiatrist and I'm like, I will never start somebody on meds. But sometimes my patients start on meds. Like sometimes their gynecologist puts them on Prozac. And then they do better. And I'm like, well, fuck. You know, so it's like there's no easy answers. And there's no dogma around this. most of my patients, I'd rather they get there without meds, but once in a while, it actually seems

to be the right choice. And so I'm just always learning, growing, evolving. Five minutes ago, I was an asshole. You know, it's like we just keep learning that. And I think there aren't easy answers, but I just want everyone to have all the information and to be able to make the right choice for themselves. And can you just end on a little bit of a note of hope with your patients? Do you see a pretty high success rate with everything we've sort of talked about in this podcast? Yeah, I think that it's sort of like there's these different layers to the journey. And if you are just struggling with some surface level symptoms and you want to feel better, you make these changes, you will feel better.

And I wish I could say it was that simple. But sometimes what ends up happening is that it's a little bit like we're peeling the onion. And sometimes when you get your health to a place of balance, then you're like, oh, I'm living completely out of alignment with my purpose. And so then it's almost like we've opened up the box for a harder challenge. So I do think like we, my patients evolve towards self-actualization and fulfillment in their life. But it can be a rocky road. And sometimes like we've taken care of the symptoms, but it almost just opens up the capacity for dealing with the big ticket issue.

And that's the human experience. That's like why we're here. Totally. So we're here for. Yeah. But like as if it like there's no like we tie the bow and like send someone off like sometimes. once in a while. Usually they don't come back to see me that often, right?

Because it's like, thanks, goodbye. But people who stick around go on a deeper trek through the jungle. I love that. Well, thank you so much for taking the time to chat with me. Thank you, Liz. I hope that you love that episode. I hope that you loved Ellen's wisdom and her advice. And I hope that there was stuff in there that you thought was actionable,

that you could start doing today, maybe with the, you know, spoonfuls of fat and regulating your blood sugar. Maybe it's just thinking about your anxiety differently. I think that a lot of my takeaways for this episode were sort of redefining the role of anxiety in my life. And that's been huge for me. So I hope that you got something from it. I cannot wait to hear your thoughts in the episode. So please screenshot, tag me at Liz Moody, tag Ellen at Ellen Borahmd. We would love to continue the conversation over on Instagram. And as I said at the top of the episode, if you know anybody who this information can help, please send it to them, share it with them. I would love, I don't know, to just have less people in the world suffering from anxiety. I just, I know what a

terrible, excruciating feeling it is. And I want nobody to have to go through that for one moment more than they absolutely have to. So yeah, that's it for me. I'll see you guys in the next episode. Have a great one. Look, I'm never going to make everything. everything that I wear organic. But your sheets, your pillows, your comforter are literally touching your skin for eight hours every single night. That is a third of your life right there with one simple swap. And if your bedding is worn out, it's trapping heat or it's made with questionable materials, your sleep is going to suffer. And so will everything that depends on it. You want a bed, you deserve a bed that you are excited to get into every single night

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