March 28, 2023

Unlocking Micro Wins and Understanding Anxiety: A Conversation with Dr. Ellen Vora

In this episode of our podcast, we sit down with Dr. Ellen Vora, a renowned board-certified psychiatrist, acupuncturist, and yoga teacher, to discuss some of the most pressing issues affecting mental health today... See show notes at:

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In this episode of our podcast, we sit down with Dr. Ellen Vora, a renowned board-certified psychiatrist, acupuncturist, and yoga teacher, to discuss some of the most pressing issues affecting mental health today. Dr. Vora draws on her extensive expertise to provide insights into the major tools that listeners can use to achieve micro wins in their everyday lives. We delve deep into the crucial topic of gut health and its impact on mental health, and explore the role that GABA and chemical responses play in regulating our moods and emotions. This insightful and engaging conversation offers practical tips and strategies to help listeners improve their mental and emotional wellbeing, and achieve a happier and more fulfilling life. Tune in now to discover how you can start making positive changes today!

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Michael: Hey! What's up, Unbroken Nation! Hope that you're doing well wherever you are in the world today. I'm very excited to be back with you with another episode with my guest and friend, Dr. Ellen Vora, who is a board-certified psychiatrist, acupuncturist and yoga teacher, and the author of The Anatomy of Anxiety. Very much looking forward to this conversation, my friend. How are you today? What is happening in your world?

Dr. Vora: Hey Michael. It's really good to be here. I'm pretty good, all things considered, my world is summer and that brings me some joy. 

Michael: Yeah, I had that same moment. I took a little bit of me time today, I was thinking to myself, you know what? I'd actually need to rest for a moment, getting really into my intuition and I was out at the pool this morning just chilling, which is something I do not historically do, but I was like, pay attention, dude, pay attention. So, I would love to start the conversation, there's so many different arenas of expertise that you have that I wanted to make the most about this time together in a way that I think will be very, very beneficial for those listening. And I actually, I'm gonna start maybe places most people don't start with you and I wanna talk about GABA. See, nobody ever does that, do they? I wanna start here because when I understood the science and the research behind GABA, it forever changed my life and I think it is the untold hero of mental health.

Dr. Vora: Okay. I thought you'd never ask. I have never been, had a podcast kicked off with GABA. I’m so for this conversation, here's the thing. We are talking about serotonin, that's the neurotransmitter that gets all the air time, we know about serotonin with depression, we know that 95% of it is in the gut, and we kind of start to recognize that's why the gut is the second brain. And we're talking about serotonin, GABA is this absolutely background character never comes up, it stands for 

Gamma-Aminobutyric Acid, and it's a neurotransmitter we need to be talking about. It is our ready for the science speak, primary, it's our primary inhibitor neurotransmitter of the central nervous system, which translation is, it's the one that calms us down, it can pull us out of an anxiety spiral, it can allow us access to that feeling of, I'm okay, I'm calm. And it's an endangered species in modern life. There's a lot about the way we're living our lives that compromise our ability to have healthy gaba functioning. One big piece of this is actually the health of our digestive tracts so just like the gut matters for serotonin, the gut also matters for GABA and their particular Bacteroides species of gut bacteria that are involved with making GABA and we're missing it. We take antibiotics, we don't eat fermented foods, and we just don't have the bacteria to make enough GABA. So, it's part of the reason we're so anxious is that we're just not making enough GABA.

But this other conversation that's way less fun is that there are certain lifestyle habits, like our relationship to alcohol and even medications like the benzodiazepines, which are things like Xanax and Valium and Ativan, Klonopin, these also compromise our GABA functioning in the long term. And so, we have to look at these things, we look at anxiety just sort at as an issue in and of itself we think it's a genetic chemical imbalance, we forget that sometimes it's a downstream effect of other things contributing to imbalance and chronic alcohol use over time is systematically impairing our GABA functioning and leaving us anxious in the short term, but also in a cumulative way in the long term.  

Michael: What is the role exactly that GABA plays just in the general scope of mental health?

Dr. Vora: Well, I think it relates to conditions like generalized anxiety disorder, panic disorder, it's basically our neurotransmitter that helps us feel calm and when a lot of problems in the brain are not sort of, it's like, when you think about Parkinson's disease, with that extra tremulousness and movement, we think there must be something added to that picture that's adding those movements, but it's actually something taken away in the brain. It's kind of the inhibitory signal has been removed and therefore the body at baseline, underneath that inhibitory signal is tremulous is making all these little micro movements similarly with anxiety, we are wired for survival and there's a lot of anxious, anticipatory, future tripping, hypervigilant thoughts. And GABA is our inhibitory signal that can talk us off the ledge, that can tell us, you know what? In this moment it's unlikely that a leopard is coming around the corner. So, we have all of this hypervigilance and GABA can help sue us and ground us and reassure us that we're okay in this moment. And if we're missing that inhibitory signal, we can have a lot of unnecessary anxiety.

Michael: Yeah. And so, when you are deep into coffee or alcohol or tobacco or I imagine the vast majority of processed foods, I would imagine that that inventory factor is taken away from you, right? And at least to some extent, would that be correct?

Dr. Vora: Yeah, I mean each of these I think has an impact on anxiety, but all for slightly different reasons. Some of them by way of GABA, some of them for entirely different reason.

Michael: So then when you factor in GABA and looking at, all right, we understand that this can play a role in helping to reduce anxiety or anxiousness or stress or whatever, various things may come along with it. How do you start to build GABA? Is it just you have to take a supplement? Is it your dietary lifestyle? Like, how do you actually increase that? One of the things I always thought about early on when I discovered it was like, I was like, Oh, more GABA better, I'm gonna take this supplement and then I have like this nice kind of reaction where my entire body's on fire for like 38 seconds. And so, I'm wondering if there, is there natural ways where we can make that uptake greater? Are there certain things we should be doing or looking out for?

Dr. Vora: Yeah. So, I do think we can promote GABA and I don't think that the go-to pathway is supplementing with GABA itself. There's really two kinds of GABAs on the market in terms of supplements. Some of them I think are not that bioavailable, they're not lipophilic enough to cross the blood brain barrier. So, they're probably not all that effective. Some of them are all too effective and they're basically just cousins with the bedside diazepines. And to me it's almost outrageous that they're over the counter because they can create physiologic dependence in a withdrawal state. So, I don't recommend the GABA supplements, but I do think there's a lot that we can do to promote healthy GABA functioning in our bodies. I encourage people to heal their gut consuming fermented foods, avoiding things that irritate the gut, which is a little different for all of us. But things like gluten, for some people, and for most of us, the industrial seed oils like canola oil are pretty inflammatory to our guts. And then making sure that we're actually resting enough that our digestive tract can heal and can function properly, and then throw in a squatty potty, which I think just helps all of us with our digestive health. And there's a lot that you can do nutritionally GABA it's a material that our body has to build and it requires the building blocks for that. We get that from our food, our vitamins and minerals and nutrients. So, the more you can eat a nutrient dense diet with a diverse, you know, you're drawing on lots of different nutrient dense foods that sets your body up to build healthy GABA.

And the last piece is, I really do think we play a role in how we're signaling our body, whether what tone to strike and when we are living in a hustle, grinding, go, go, go lifestyle. We're pretty much telling our brain that we're not valuing this inhibitory signal. But when we value leisure, when we rest, when we take that cue to go to the pool in the morning or practice yoga or breath work or meditation, or even just like getting craniosacral therapy or reiki, or doing a progressive muscle relaxation, all of this is kind of like doing, going to the gym for GABA. We're practicing that inhibitory signal and that relaxation response in the body.

Michael: Yeah, that makes a lot of sense. But I feel like, and this was my journey, right? And I've heard you mention things like Sibo and C. diff previously, both of which I've had luckily, and had to go through this whole process of gut healing, a few FMTs, blah, blah, blah, so on and so forth. And then getting to this place where finally, because of some supplementation, a lot of working with MDs and functional medicine doctors have been able to get on the right path. And gut health now has become more of a center focus in this conversation around anxiety, around depression, around mental health issues and ailments. But why is that? Like, where does this conversation come from and why is it so important? Because I'll tell you this, if I go to McDonald's and these guys are gonna fucking sue me one day, I feel like shit. Right? And yet we torture ourselves to continue to do that thing. And so, I'm wondering like, a- if we can create a pathway for people to understand why gut health is so important, maybe we can alleviate some of the chaos of the, for lack of a better term, self-torture we put ourselves through by consuming things that hurt us.

Dr. Vora: Okay. I wanna take a couple different approaches to this. So why is our gut health matter to our mental health one is everything we were just talking about with GABA, with serotonin, a lot of our neurotransmitters that are central to how we feel are manufactured in our gut or stored in our gut. So, the health of our gut directly impacts what kind of neurotransmitters we have to work with in terms of whether we can feel calm or happy. The gut also plays a really critical role in how inflamed our bodies are, and this is a competing hypothesis for understanding depression and anxiety. We have all been indoctrinated with what's called the monoamine hypothesis of depression, to think about it as our mood disorders are a genetic chemical imbalance. Your genes determine what your serotonin functioning is like, and therefore you just have this destiny of depression. And while there's validity to that hypothesis, it's not the whole story and in many ways it's our least hopeful story about mental health. And competing hypothesis is what's called the inflammatory or cytokine hypothesis of depression that understands that sometimes a depressed brain is really just an inflamed brain, and it's actually an adaptive response to inflammation if you're inflamed on the proverbial Savannah evolution, you drank the wrong pond water, you have an acute infection and it's adaptive to wanna socially isolate and retreat to your cave and rest until your immune system can get a foothold on that infection adaptive response in those circumstances. But in modern life where we're all walking around in a chronic low-grade state of inflammation from our processed foods and our compromised gut floras, then we are in a chronic low-grade state of this sick response which happens to look a lot like what we call depression. So, when our gut is unwell, when we lack a diverse ecosystem of beneficial bacteria, when we have leaky gut, this is very provocative to our immune system, it's dis calibrating our immune system, and our body ends up inflamed, our brain ends up inflamed, and then we don't feel good. But to me, the last piece of this conversation is about the two-way street of communication between the brain and the gut. And culturally, we're now beginning to appreciate our brain talks to our gut. We know that if we're anxious, if we're stressed, we might have IBS symptoms, we might have nervous diarrhea, but what we have to increasingly appreciate is that the gut is also talking back to the brain.

So, if our gut is healthy, it can send a memo, everything's copacetic down here. Go have a great day. And if we're inflamed, if we've decimated our gut floor from a course of antibiotics, if we're eating something we don't tolerate, our gut is gonna send a really different message up to our brain. It's gonna say, feel uneasy, feel anxious, so that you'll rest, so that you'll make different choices so the gut can heal. And so, a lot of us are going through our lives feeling chronically unwell, simply because our gut is so unhealthy, so we cannot overlook it. It's very hard to have good mental health if you don't have good gut health.

Michael: Truth. You know, I remember being in the crux of dealing with SIBO and just being like, I cannot focus on literally anything. I cannot function, I cannot operate, I cannot do anything but this. And it took a couple of years of my life just really trying to figure this out and understand it. And it wasn't until I did a methane test when someone was like, oh, I think I have the solution here, that things started to change. And then I went the elemental diet route for 21 days and I learned a lot about the capacity I have to push myself through discomfort. And, you know, you said something and I had written a note here. I really, really loved, and I think it actually plays a role in this conversation. You said we need wounds because it expands our capacity to heal and I think that so much of that comes from the willingness to just look internally and understand the truth about where we're at and not run from it, and not hide from it, and like, not suffer the stuffing it down. And so, I'm wondering when you said that, what did you mean? And if you could expound on it?

Dr. Vora: So, can you remind me where this might be edited out in post-production, but what, can you gimme some context? ‘Cuz I don't remember that line.

Michael: Yeah, it was a conversation that you were actually having with one of our mutual friends, Lewis Howes, and you were talking specifically about his journey with his childhood experience and then now looking at it and changing the way that he operates in the world and relationships particularly, and what you said is we need wounds and I think you are in the trauma space in this conversation. You said we need wounds because it expands our capacity to heal. So that triggers the memory.

Dr. Vora: So, here's what I think about that. I think that what are we doing here as humans? Like what really is this? What is existence? You know? Who really knows? It does feel to me that it centers on some level around our relationships with each other and our ability to shift from a place of fear and separation to one of love and trust and connection. And I saw this meme recently that really made me laugh and it was like a picture of God and it was somebody being like, everything happens for a reason, which is this cliche spiritual bypass. Right. And then God responds a reason that you make up after the thing happened. And that resonates for me, partly because you feel called out, but I'm kind of like, Yeah, exactly. Like I think that there is value to making meaning out of the unfoldings of our lives. And it's not to say like this was all preordained, this was as it was meant to be, it's certainly not the spiritual bypass of like, Oh, I'm uncomfortable with this shitty thing that you've been through, but you know, everything happens for a reason to kind of make my own discomfort go away. I think this is about cultivating resilience and when we can make meaning and see some silver lining in our struggles, it helps us meet the challenges in our lives with a little bit more resilience. And I think that when we have wounds, whether it's childhood trauma, whether it's Sibo, whether it's everything in between, this expands our capacity for empathy and it allows us to feel much more connected with others suffering. And I think that it is part of what we're here to do as humans is work through these challenges and then be there for each other, let each let ourselves feel less alone and show up to help. And I think that about my body is sort of this vessel that feels related to my vocation like I'm a precious, precious snowflake with all kinds of sensitivities and I was quick to burn out and I was quick to be broken by the various poisons of modern life. And I think it's actually really helped me help other and if I were somehow just like could eat anything and could have healthy digestion without any extra effort, I'm not sure I'd be so good at my job. And I think it's really helpful that I am a canary in the modern coal mine and I know all the ways that our modern world poisons us, and I think it helps me show up and help others.

Michael: Yeah, I love that. And I actually, I resonate with that a ton. You know, this audience knows, and so I won't go into the full crux in depths of it, but you know, having an ACE score of 10 being homeless as a child, all of the things that come along with that set me up for massive, massive failure. And I found myself in my early twenties, basically destroying my life, and my first book I wrote, it's like standing inside of the house that I said on fire and I'm holding the matches. And that felt very true because it was like, the theory thing that I wanted to do was run from it, run from it, run from it. But what I'm hearing you say is like by embracing it, you can actually create this massive and beautiful change in the world. You can step into empathy and grace and hope and give people honestly and what I think so much of what conversations like this is, is exposing the tools to help other people like follow, right where we've been. And you know, I think what's really interesting is that so many people who survive trauma, like they silence themselves, right? And it's an adaptation for survival, putting ourselves in this position of being quiet, being hidden, being small, never taking acknowledgement of your accolades, never showing up, never living fully into your ability. And so, I'm really curious like, and maybe part of this is geared towards you personally, but just as a general question, how do you find your voice again?

Dr. Vora: So, something you just said hit something in me and just unlocked something, and I've never thought about it this way before, but basically like part of the reason that we're silenced after trauma, it's an adaptation, it's a coping strategy, it’s also related to shame and just not wanting any eyes on us feeling like we're broken. And I think there's nothing quite as revelatory as hearing someone else describe their shame, and it lines up with that secret that you hold within yourself as what you consider the most unspeakable, most shameful thing about yourself. And when you hear somebody else talk about it, it's an unlock, it gives you permission to integrate and embrace what you think is, you know, unacceptable about yourself. And I think that part of how I find my voice is this world doesn't make it easy, right? It's so uncomfortable to put yourself out there. And part of my mission in life and what I feel like I've been assigned with is having this different perspective on mental health. Now mental health is having a moment, that's for sure. But there's so many triggers and so much sensitivity around it. Like we are still grappling with stigma, we're grappling with giving ourselves permission to get help, giving ourselves permission to take medication when we need them. And so, like for me to come out and say, let's think about mental health differently can be perceived as really controversial or invalidating or dismissive of the value of medication, there are all these considerations, there's so much nuance to it, and so I have to really come back every single day to my intention, which the mantra in my mind, which I don't know if this explains it perfectly, but it's just intention to heal. I feel like I have a role in this conversation around mental health, which is opening people's eyes to a different approach. One that I find to be more empowering, more hopeful. And as long as I know that I'm queuing close to that intention and I'm in alignment with that, like the arrows in my back don't hurt quite as much, and I feel like all I can do is show up and do my best to spread a message that I hope brings people comfort and hope.

Michael: I sigh because I relate with it and it often feels like this tumultuous uphill battle. For whatever reason, this is my feeling and belief on it with the conversation around mental health right now, it's almost so incredibly dogmatic that if you push against the grain, it's like you're gonna get fucking canceled, people are not gonna like you, they're gonna say that you have no right talking about these things. And what's so fascinating to me, it's like everyone heals differently, everyone needs a different way to operate and function in the world because for me I'll be honest with you, and I shared this on the show all the time, the super incredibly gentle self-care talk does nothing for me. Nothing. You could do less, actually. And what I need, because I was a person who quit on myself all the time, well, I quit on everything I ever did in my entire life. What I need is to kick myself in the ass sometimes in a gentle manner, I'm not belittling myself, I'm not being defamatory to myself, but it's like, dude, get your shit together. Let's go. And that kind of pushes me and thrives, but I feel like this dogmatic approach comes so much because like, here's the DSM and here's how things are supposed to work, and this is how it's supposed to be. What do you think in general is true about what has worked historically about mental health conversation and how do we start to bridge this gap about like, actually there might be more than one way.

Dr. Vora: I'm like shaking. There's so much here, it's such a good topic to bring up. I mean, I'm with you that I don't think it's my mission in life is that sort of softer self-care conversation. I'll admit every once in a while, when the cancel culture seems just a little too much or I feel like my nuance message is being misunderstood, I will retreat and put out on Instagram like, just go easy on yourself today, and I'll get hundreds of likes and everyone's like, Oh my God, that message really resonates. And it's like, you have no idea, this is just me hiding], you know, this is just me taking a day off from inconvenient truths. But I think that, you know, we meet it all like I'm glad someone's out there ‘cuz somebody does need the message of to go easy on themselves like that's how broken our world is, is that people don't already know to be loving or gentle or kind to themselves. We don't get that message; we don't internalize it in childhood so it actually is revelatory for some people to see that on Instagram. It's not my mission in life to be like a champion for that more coddling enabling approach. As much as I would get more likes, like I think that the conversation up until now, it's sort of like, if that was gonna work, it would've worked by now and it hasn't. And I think we need to do things differently if we want different results. Now I do think all exists, like there's this evolution and if you look in the past, mental health was seen, like mental health issues were seen as a moral infirmity, it was something to whisper about, it was something to feel shame for and thank goodness we have evolved that. So, we're moving past that, we are reducing the stigma around mental health issues. This is good. And then part of what's happened, and I think it was a really well-intentioned movement, was to do the disease model of mental health to say, hey, Depression is no different than diabetes. You wouldn't feel ashamed for taking medication for diabetes, so you don't need to feel ashamed for taking medication for depression. The spirit of that is something I'm really in alignment with. I don't think anyone should feel shame for anything, let alone for depression, but I do actually think it's different than diabetes. Not in a shameful way, but I think that diabetes is a little bit more mechanical. Depression has mechanical aspects, but it also has psychospiritual aspects. And oftentimes, you know, even what we're calling depression as if it's a diagnosis it's a real misunderstanding, I think, of depression as a symptom, it's not a diagnosis, it's a symptom. It's the body communicating, Hey, something's outta balance here. And to me it's just the beginning of the inquiry that's when we roll up our sleeves and start investigating what's outta balance? Is it genetic? Is it epigenetic? Is it childhood trauma? Is it something in the physical body? Inflammation, micronutrient deficiencies, chronic sleep deprivation, poor gut health, hormonal imbalance, a thyroid condition masquerading as depression. It can be all of these different physical states of imbalance. And then you wanna identify that and address it on the level of the physical body. And sometimes it's the body communicating, I have a fundamental human need that's going unmet.

Michael: I appreciate you being willing to go into the throws of what this is. Right. And one of the reasons that I wanted to go here with you is because a - I know that you openly talk in the same mannerisms in which I do about many of these things, but also because I think that there's a validity to the conversation. You know, my fear now, having not only just done the work, but been deeply, deeply involved with mental health for now a decade, having been trained by people like Bessel van der Kolk, Pete Walker, Gabor Maté, you know, it's like the more I learn, the more I actually come to realize, and I'm curious about this, I'm gonna ask this question. Is have we overcorrected as a society because of not addressing mental health for so long that now everyone so quickly moves to gaslighting, anxious, depression? And you said something that like, honestly, it felt like this incredible like boom explosion in my brain where you were talking about the difference between real anxiety and false anxiety. 

Dr. Vora: Yeah. So, I might actually answer this in a way might be different from what you're expecting I'm not sure, but I actually don't really think we've overcorrected. I know that right now it's like trendy to identify with a mental health diagnosis. And if you're on TikTok, it almost feels like you know, you belong if you have anxiety and ADHD. I actually think that what was always wrong was thinking about these as fixed traits and sort of genetic destinies, and I think what we're missing, I do actually think that these constellations of symptoms that we call anxiety or ADHD or depression are actually more common right now. So, I think that's true and valid, I just think that it's not that we've increased screening or our genes have changed in the last 50 years. I think that this are manifestations of states of imbalance and that's what's on the rise. And so, I think we actually have even more work to do right now as a society to understand the ways that we're really sick and we're really outta balance and to start addressing that at the root.

Michael: Can we get balance back then? Because I fear of so many people say, I am this thing and they've real, and they fail to realize that they're actually more than that.

Dr. Vora: Yeah. Diagnoses are such an interesting thing because it's grounding sometimes and can feel really comforting to finally give a concise description of something that felt so overwhelming and vague in your life and sort of like you were just struggling in all these subtle ways and then someone says, you have ADHD and you're like, Oh, that's why I felt like this was so hard and I felt different from other people. And everyone else was just going about it, and they weren't losing their piece of paper and they were understanding the instructions from the teacher, and they weren't failing out of this and dropping out of that.

And you're like, now you've made sense of this. So, to have a diagnosis can be so grounding and comforting. But where we get it wrong culturally is that we get really identified with our diagnoses and we assume that there's no changing it. And I just fundamentally disagree with that, partly because that's the work I do every single day. I witness my patients walking away from lifelong diagnoses. They've assumed that their anxiety or their depression was a genetic destiny, that it was a fixed rate, that it would always be so. But then we changed their diet, healed their gut, got them off caffeine, you know, addressed different states of physical imbalance, got them to some connection to community or meaning or purpose in their lives, and got them off birth control and gluten. And then in the end, they are no longer anxious and they don't identify with those symptoms anymore. And so, it was never a destiny, it's in functional medicine we say genes loads the gun, but environment pulls the trigger. Genes play a role they absolutely play a role, they create a predisposition that's why we see this run-in families, but there's always an environmental piece. We can't do a whole lot about our genes, we can do a whole lot about the environmental influences that are impacting how our genes manifest themselves in our lives.

Michael: And I did my genetic markers, like I have a disposition for MTHFR mutation. And once I found that out and I started taking the correct vitamins and things like that, like I felt this amazing cognitive shift, there's no arguing, but it was also like, Oh, I'm gonna eat healthy, I'm not gonna be 350 pounds anymore, I'm gonna stop smoking two packs a day, I'm not gonna drink every day. And it's like, for me, what happened was effectively for lack of a better way to phrase that. I, I had a massive fucking rock bottom, 26 years old, life was a disaster, it was like change or die literally, there was no way I'd be here without having that conversation with myself. And I think that unfortunately, and this is where I'd love to have your opinion, and maybe we can demystify this a little bit, but I have found the deeper I've been in the personal development space, having conversations, the depth of the people who have been on this show, my own journey, the people I've coached, the one thing I always come to, it seems like change doesn't happen sand's the rock bottom moment. Is there a way to mitigate that? In all of your experience, in everything you've taught, can we give people to give them the tools to avoid that fucking moment where they're like, wow, change or die? Because I would really love to be able to do that.

Dr. Vora: That's an interesting question and I think your rock bottom is quite rock bottom. And I think what ends up happening is that whenever we do end up changing in our lives, we look back and it was that watershed moment when we stopped continuing to go down and we started going up that we call our rock bottom. But you know, it actually could have been lower that just happened to be the moment when we changed course. And I think that, what does it take to get the right help? I prefer to not think that it requires getting so low and so hopeless that like something has to change or else we're just doomed. I prefer to think that, I mean, that's part of why I go on podcasts and talk about this, is that I actually think that the insight that there's a different approach to this is powerful and I think that part of what happens is that people very understandably feel pretty demoralized and defeated by the existing treatments. Like a typical person feels like their body is really unhealthy, but they've tried all the conventional wisdom, they're like, yeah, I tried eating more fruits and vegetables or I tried exercise, it didn't make any difference in fact, I just started yo-yoing or whatever. And so, they feel defeated, they're like, I tried that it didn't work. And you just wanna give up or, I tried every medication under the sun, nothing helped so I give up and I just wanna then stay in this low state because you know, we think it's like, well, why don't you wanna get better? But the real issue there is that in a very reasonable way, why do you not wanna have your hopes dashed again? And so, I think when people think that all that's out there is what they've already tried and hasn't worked for them, they don't wanna work harder at getting better, ‘cuz then you just get you, it just drops you low again and very understandably, humans wanna prevent and avoid that. So, I think it's helpful for people to realize there's a fundamental different way to approach this one that makes biologic sense and that can give people a reason for hope.

Michael: What are the biological ways that makes sense? Like if we were to start giving, people call it micro winds, just starting to get them on the path like what does that look like?

Dr. Vora: Yeah. So micro winds, I think two really good micro winds to start with our sleep and blood sugar. So, with sleep, every single mental health struggle under the sun is improved by better sleep and in modern life, why? A lot happens while we sleep. Most of all, I mean, certainly a rest, it's a restoration in our brain, it's also when our glymphatic system does all of the cleanup in the brain. So, we might be familiar with our lymphatic system that's our series of vessels throughout our body that's removing waste. It's collecting, it's bringing it to the kidneys or the sweat gland, it's helping us get rid of metabolic waste and toxins. And their brain also has a lymphatic system of its own, it's called the glymphatic system and it happens to do its job at night, it's kind of nocturnal and this makes sense. You don't want the garbage trucks going around the alleyways of the city during working business hours when there's a lot of commerce and you know, traffic, you want the garbage trucks to go around in the middle of the night when the alleyways are clear and there's no real bustling activity happening. So that's how it works in the brain. And so, if we are getting on a chronic basis, inadequate sleep then it's almost like the garbage trucks only ever got to do half their job every single night and there's an accumulation of towel proteins, oligo mirrors, the same things that are the residue that builds up in brains of Alzheimer's patients and this can build up if we're not clearing it out every night. So, it impacts our functioning, it impacts like any brain that's not functioning optimally is a person who's not feeling optimal mental health. And so, we need to sleep better, modern life makes it really hard to sleep well. We have most of all a really disrupted circadian rhythm from our light cues and the whole sleep wake cycle or circadian rhythm, it's cued by light and this is actually a really brilliant design ‘cuz if you're on the proverbial Savannah of evolution, then if it's daytime, it's by definition light out. ad if it's nighttime, it's by definition dark. So, to use that to cue our hormones, to make us awake during the day and sleepy at night was like a brilliant design. And I don't blame evolution for not anticipating the plot twist, which is that we were gonna invent the light bulb and eventually Netflix and eventually Tiger King and then no one's gonna sleep anymore. I think that what happens is were indoors during the day not getting sunshine into our eyeballs and at night when we should be in darkness with only the moon and fire, we're surrounded by a psychedelic light show of laptops and phone screens and overhead lighting and light pollution, and so we're never getting that cue to secrete melatonin and get sleepy. So, fixing people's light cues sunshine into their eyeballs first thing in the morning, blue blocking glasses from sunset until bedtime is a really great way to set them up for better sleep and then protect their mental health over all.

Michael: So, we have micro win number one. Get your sleep-in check micro win number two – blood sugar.

Dr. Vora: Yeah, so blood sugar. So, in our modern environment, we're living with this diet that's built on a foundation of refined carbohydrates and coffee drinks that are secretly milkshakes, and then rose all day and here we are on a blood sugar rollercoaster. So, when our blood sugar spikes insulin chases it, then our blood sugar crashes. And at that point our body responds by secreting our stress hormones, cortisol, adrenaline, that's the design, that's what cues the liver to break down the storage of starch that it keeps so we can restore normal blood sugar, our organs don't fail, we live to see another day it's a decent design, it's good that we have these checks and balances, but it has as this side effect, a five-alarm fire of a stress response in the body. And so just because our blood sugar crashes, we are in all of these unnecessary stress responses that feel identical to anxiety or even panic, or feeling easily overwhelmed, and so this is causing untold amounts of unnecessary suffering, and it's preventable. And there's the definitive solution, which is a blood sugar stabilizing diet, which for some people feels like an exciting, empowering way to go forth and support their mental health for someone else that feels daunting and they're just like, it's too much of a departure from skipping breakfast and then having a pastry and then not just for dinner. And so, if it feels overwhelming, there's a hack that has helped a lot of my patient which is to simply take a spoonful of something like almond butter, and you might do it an hour or two before your typical blood sugar crash. So, if you are hunting for cookies at three in the afternoon, or picking a fight with your partner at 5:00 PM or waking up throughout the middle of the night, those are probably your blood sugar crash times and you might take a spoonful an hour or two before that and it gives you the safety net of stable blood sugar that will blunt a blood sugar crash and then you don't have that unnecessary stress response.

Michael: Yeah. I love both of those micro winds and for me, they've played a pivotal role in my life. Getting my circadian rhythms in control has helped me so much because now it's like by 9:30 I'm crashing and then I'm up at 5:15, 5:30 like clockwork, no alarm, and I feel good. Right. I think that's the part where there's a little bit of suffering first right in the beginning, and that holds true, I think, with whether it's sleep or sugar. And there's the word that comes to mind about this is taking control over your life, and I think one of the very difficult aspects that we have, I've had this idea sitting with me for probably about a year or so now, recognizing that at least for myself and my journey, believing and filling inherently true that trauma and abuse, it's not like the scars and the cuts and the burns that we carry. You know, my mom cut my finger off when I was four years old, we were homeless, the list goes on and on. It was like, Oh my God, actually, the thing that this is, it's a theft of identity. I've lost who I am and I've never had the safe space to discover that. And then it felt like when I was in the throes of the chaos of my life, it was like actually, what I'm doing is I'm hurting myself in the same way that they hurt me because it felt like that was the normative aspect of the familiarity of life, of love, of pursuit, of happiness only coming to realize that in fact, self-care is kind of doing the opposite.

And so, what I'd love to know is what are your thoughts about people who are self-harming in a way that isn't necessarily classified as self-harm? Cuz I didn't realize like eating fucking gummy bears and chocolate cake for dinner every night was like me hurting myself to make myself feel invisible because of forcing to be invisible in childhood. I know that's a very large loaded question, but like where do you start with taking control back of your life in this?

Dr. Vora: Oh, it's so hard. I really love what you said about this loss of identity with trauma and I'll sort of add to that. I think it's a program in your brain of being unworthy and part of what I consider my task as a parent of a six-year-old who just walked in the front door. So, there'll be like some noise in the background now is like to teach her how to self soothe we're getting currently like a plus on that one and to let her know she's a blessing, which is, you know, there's many ways to interpret that. But like for her to know that she's divine, inherently worthy of love, infinitely worthy of love. And for so many reasons, parents own unprocessed trauma, substance issues, mental health issues, a household that's been thrown, a curve ball, systemic racism, marginalization of any sort. There's so many reasons why parents aren't able to show up good enough for their kids and it's not to blame them, right? Like if you try to blame, you just keep going back generation after generation, after generation and it's like we just keep carrying this forward. But what ends up happening is that a child is internalizing, well, there must be some reason I'm not getting my needs met, there's some reason that I'm, you know, not being taught this message of how cherished I am.

And so, I think part of the story you tell yourself when you're traumatized is, I'm unworthy of love and I think that that's part of what's so damaging. And so, this idea of what do you do to take care of yourself? Part of it is a very willful, proactive choice to say, I'm reclaiming my worthiness of love. And it's not like you can just snap your fingers and feel it and believe it, and I don't expect anyone to be able to easily switch over. But you can talk to yourself about this and explore it and practice it. And my friend Kimberly, she's an author of an incredible book called Call of the Wild. She runs post in on Instagram, she was doing the Wim Hof method where she was submerging herself in an ice bath and doing breath work, and she was like, why am I doing this? Because I love myself. And for me, that's a mantra I come back to all the time. Anything we do, you wanna ask yourself, why am I doing this? And you wanna make sure the answer is because I love myself. And a piece of chocolate cake can be either or you can eat the piece of chocolate cake because you love yourself or you can say, I don't feel like eating that right now because I love myself. And so, there's no dogmatic answers that line up with this, it just has to be a personal question we ask ourselves all the time. And I think part of what happens with trauma is that we lose connection to that being the baseline that we're worthy of love. And I think that part of how we start to take care of ourselves and not self-sabotage is to see ourselves worthy of feeling good, receiving good things, and being inherently, infinitely lovable.

Michael: I absolutely love that you said that, and that feels like coming back to this idea about making meaning, right? Ad us being the arbiter over a reality and as the individual deciphering what words mean, what actions mean, what things mean, and not getting tied into the dogmatic approach of it all because my God, I mean, you can only meditate in journal and fucking yoga so many times, right before you're like, wait a second, hold on. What do I actually need? When people hear this though and they're like, yeah, sounds great, thanks for telling me I need to love myself. I fucking hate myself. I hate my life. Everything's a disaster. How do we let go of that? Because I know there are people listening right now and that's the first thing they thought ‘cuz that's what I would've thought if I heard this for the first time.

Dr. Vora: It's such a good question. Let's see if I can kind of think out loud on this. I think this is tough. I think part of how we change from hating ourselves to loving ourselves is witnessing ourselves go through our lives with integrity and kindness. And I think the more we have that attitude, which is understandable, there's no blame here, right? If you've been deeply traumatized, if you've been kicked the curb at every corner in juncture of your life, of course there's so much hatred. But then it reinforces itself because we go through our lives spreading that hate and spreading the negativity, and then we witness ourselves doing that and we just further hate ourselves. And so, if you can recognize life is not fair and you've been dealt a shit hand and here you are and you want to have access to a little more joy and a little bit more fulfillment, it starts today, where the next five minutes do something that makes you think, I like that guy, he's out there, a flawed human, like all of us doing his best, to do the right thing to grow, to show up humbly and open to growth. And I think that we do it in how we talk to the person at the grocery store checkout, and we do it in whether or not we call our grandma. We do it with whether or not we look at ourselves when someone calls us in on something. If they're all of these ways that we can earn our own respect, then I think that's actually part of the building blocks to developing self-love.

Michael: Yeah. It's very beautiful. And I would contend with that all day long and say that it's so much about that. And I would add a small caveat and just say, and celebrating yourself and be like, I made it five minutes. I did it. You know, for me, early on, the greatest victories were like, I brushed my fucking teeth today and even in saying that, that was like a hard truth to sit in like, that's the thing I did today and being okay with it. And my hope is that people will give themselves some grace and some of the capacity to recognize like, this isn't overnight like it's gonna take you the rest of your life to go through this, you might need to toss in some psychedelics here and there, go to some therapy, read some books, listen to podcasts. But your life can be different and my hope is always that hopefully the tools will help people do that. This has been an amazing conversation, my friend before I ask you my last question, can you please tell everyone where they can find you?

Dr. Vora: So, the two best places to find me are on Instagram where I'm @ellenvoramd, and then I've really distilled my life's work into this book called The Anatomy of Anxiety. And that's pretty much all I got, everything I bring to my work with patients is in there I say it better there than I ever say it one-on-one with patients. And I think that my hope is that anyone struggling, who wants a reason to be hopeful, who wants a different way of thinking about mental health, that if it's right for you, that these ideas resonate and that that book can be helpful.

Michael: Brilliant. And of course, we'll put the links in the show notes for the audience. My last question for you, my friend, what does it mean to you to be unbroken? 

Dr. Vora: So, this is the central thesis of my book, is to think about our moods as either false or true, either physical and avoidable or purposeful. And I think to be unbroken is to recognize that some of the ways we feel broken, are our body communicating in balance. And so, we really do wanna actually address some of it. We don't just wanna coddle and enable and ignore the ways we get outta balance. We wanna identify it, address it, and be less broken in that sense. And at the same time, we don't really need more messaging telling us we're broken and need fixing and you know, better get up and do that thing. I think we also need to recognize that we are perfectly full of flaws and nooks and crannies and some of the ways that we feel outta balance is a communication from our inner compass telling us slow down, pay attention. There's something not right in our personal lives, in our communities, in the world at large, that we have some unique perspective or some unique contribution that we can make that can be helpful. So, some of the ways that we feel broken is actually purposeful and can we honor it and heed that call so that we can carry out purposeful action.

Michael: Beautifully said. I feel that. Thank you so much for being here, my friend.

Unbroken Nation. Thank you so much for listening.

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My friends, Be Unbroken.

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Ellen Vora, MDProfile Photo

Ellen Vora, MD


Ellen Vora, MD is a board-certified psychiatrist, acupuncturist, and yoga teacher, and she is the author of The Anatomy of Anxiety. She takes a functional medicine approach to mental health—considering the whole person and addressing imbalance at the root. Dr. Vora received her B.A. from Yale University and her M.D. from Columbia University.

Michael UnbrokenProfile Photo

Michael Unbroken


Michael is an entrepreneur, best-selling author, speaker, coach, and advocate for adult survivors of childhood trauma.