Extend Podcast with Darshan Shah, MD

Episode 135: Sarah Ann Macklin: Self-Compassion and Sustainable Behavior Change
Release Date: February 3, 2026
Guest: Sarah Ann Macklin, nutritionist, model, researcher, and host of the “Live Well Be Well” podcast

Episode Overview

In this rich and deeply personal conversation, Dr. Darshan Shah welcomes Sarah Ann Macklin to discuss the intersection of self-compassion, mindset, and sustainable health behavior change. Drawing from Sarah’s journey from high-fashion modeling to nutritional science, the episode explores why knowledge isn’t the barrier to good health—our self-worth and inner dialogue often are. Together, they break down the science and psychology behind lasting change, the role of stress, the pitfalls of comparison culture, and practical frameworks for cultivating a mindset that supports health for the long term.

Key Discussion Points & Insights

1. Why Most People Struggle to Get Healthy

• Mindset over Knowledge: Despite providing personalized, evidence-based advice, Dr. Shah observes many patients struggle to take the first step. Sarah identifies "coming from a place of lack"—low self-worth and lack of self-compassion—as the core issue.
  • “People always choose it from a place of lack. And a big part of that is self compassion.” – Sarah (02:53)
• Self-Compassion Defined:
  • Not about being narcissistic or self-pitying, but “being your own best friend.”
  • Composed of three elements: self-empathy, mindfulness, and resilience.
  • Quote: "I define self compassion as three things. One is self empathy... Mindfulness is the next...and then that shifts you into the resilience phase..." – Sarah (07:43)

2. Sarah’s Personal Journey from Modeling to Nutrition

• Felt out of place and “never good enough” both in school (due to undiagnosed dyslexia) and in modeling (where relentless comparison and body scrutiny dominated).
  • “I don’t believe anyone is on a mission without their personal story behind it.” – Sarah (10:01)
• Near-fatal health crisis at 23 (urosepsis, E. coli), later realizing chronic stress rooted in self-worth was the underlying issue, not just physical health silos.
• Realized after formal nutrition training—and being diagnosed with dyslexia by a supportive professor—how self-compassion transforms self-perception and direction.
  • “That was my first compassionate moment...somebody had shown me empathy...and I was like, whoa, I’ve never had that feeling.” – Sarah (15:30)

3. Nutrition, Mental Health, and Lifestyle Interventions

• Early work influenced by the SMILES diet trial by Felice Jacka, showing that “a third of the people in the [Mediterranean diet group] overcame that chronic depression just from food.” (21:58)
• Even non-nutritional support (the “befriending group”) made an impact, sparking interest in how connection and mindset shape health outcomes.
  • “What if we put them together?” – Darshan (22:27)
• Omega-3s studied as interventions for neurodivergent children, with significant improvements to reading age and cognitive function (24:48).
• The “calories in, calories out” paradigm is challenged—nutrient density and eating patterns matter far more than calorie restriction alone.
  • “Calories in, calories out, does not work...You have hunger for nutrition.” – Dr. Shah (26:38)
  • “You don’t get good hair and good skin from a low-calorie diet... you get that from an abundance diet.” – Sarah (25:58)

4. The Problem of Comparison and the Social Media Age

• Modeling was an early version of today’s omnipresent comparison trap: “Modeling is now very similar to the world that we live in. I compared myself 24/7… That’s the world we live in now.” – Sarah (32:11), (32:45)
• Cites cultural shifts, e.g., the introduction of Western media to Fiji rapidly increasing eating disorders and body image concerns.
• Now, both men and women are impacted; social media has heightened body dysmorphia and eroded self-worth across genders.
  • “Comparison is the thief of joy.” – Sarah (33:24)

5. How to Cultivate Self-Compassion for Real Change

• Myth-busting: Self-compassion doesn’t dampen motivation; it actually bolsters it.
  • “We think self compassion dampens our motivation. It actually motivates us.“ — Sarah (34:14)
  • “Imagine every day going into work and somebody putting you down. After a while you’re like, I don’t want to be here...that’s how we talk to ourselves.” – Sarah (34:18)
• Practical Tools:
  • Check your internal dialogue: “Would I say this to a friend? If not, why am I saying it to myself?” (35:35)
  • Awareness exercise: note down every negative thought in a day to reveal the extent of self-criticism. (36:36)
• Science of Negativity Bias:
  • “We have 60 to 80,000 thoughts a day, and 80% of them are negative.” – Sarah (36:09)
  • “You need three positive comments to balance one negative one.” – Sarah (36:20)
• On Positivity vs. Compassion:
  • “Compassion isn’t about being positive, it’s about acceptance.” – Sarah (37:25)

6. Behavior Change in Practice

• Sarah describes two patient archetypes:
  • Optimizers: High-achieving, always pushing for more, but still stemming from a sense of lack.
  • Lapsers: Repeatedly fall off the health wagon due to low self-worth.
  • Both groups share a root challenge: “not good enough” feelings.
    • “Different personalities, different problems, but same at the end of the day, coming from the same place of lack of self love.” – Darshan (45:37)
• She implements detailed intake forms that stealthily assess self-compassion, unmasking mindset barriers to change.
  • "Are you hungry? Who are you eating with? How do you feel? All these moments start showing up ...they’ve naturally come to that conclusion of how they’re eating, where they’re eating, how they’re feeling." – Sarah (51:02)
• Emphasizes habit building, not restrictive diets. Health isn’t a single checklist or perfection but “consistent habits, protein and veggies first, whole foods, less restriction and more variety.” (Takeaway at 65:41)
• The stress of rigid routines or diets counteracts health: “If a plan or a routine...is stressing you out, you are counteracting what you’re trying to achieve.” – Sarah (59:33)
• “Mindset is the bricks and mortar of the house—if you’ve got a steady foundation, everything else becomes easier.” – Sarah (63:03)

7. Key Research Insights

• Alia Crum’s Work: The “mindset effect” – believing you have a gene (e.g., FTO) affecting metabolism causes physiological changes even with the same food/environment.
  • “The only thing that was changed was the words they spoke to themselves.” – Sarah (62:03)

8. Practical Advice & Memorable Exercises

• Exercise: “Do the ‘Freaky Friday’—imagine you’ve swapped bodies with your best friend. You’d probably treat their body with more care than your own. What do you need today?” – Sarah (63:50)
• Health change starts with ‘why.’ “If it’s just to look good in a bikini, is that because you don’t feel good enough now?” (53:19)
• Quick fixes never last; habit and self-worth are the strongest predictors of sustained health.

Notable Quotes & Memorable Moments

• “If something feels uncomfortable, you should lean into the cringe because that’s actually where the work needs to be done.” – Sarah (02:57)
• “We’re taught to be compassionate to others...very rarely are we taught to be kind to ourselves.” – Sarah (05:10)
• “That’s how I see self-compassion: the bricks and the mortar of the foundation for your health.” – Sarah (05:30)
• “Self-compassion is one of the most courageous things you can do.” – Sarah (07:21)
• “Would I say this to my friend? If the answer is no, then you shouldn’t be saying it to yourself.” – Sarah (35:35)
• “Comparison is the thief of joy.” – Sarah (33:24)
• “Mindset is the bricks and mortar of the house—if you’ve got a steady foundation, everything else becomes easier.” – Sarah (63:03)

Timestamps for Key Segments

• [02:53] – Root cause of failed health behaviors: lack of self-compassion
• [07:43] – Sarah defines self-compassion
• [10:01] – Sarah’s personal story: from school struggles to the modeling industry
• [15:30] – Dyslexia diagnosis and its role in self-understanding
• [21:58] – The SMILES trial and evidence for food-mood connection
• [25:58] – Abundance diet vs. low-calorie diet: effects on well-being
• [32:11] – Comparison in modeling and today's social media
• [34:14] – Self-compassion as a motivator (not a dampener)
• [36:09] – Negativity bias: how many negative thoughts per day?
• [40:22] – Internal Family Systems, self-reflection, and breaking the auto-pilot loop
• [45:03] – Client archetypes: optimizers vs. lapsers
• [51:02] – Integrating stealth self-compassion assessment in client intake
• [59:33] – Stress as the key underminer of health routines
• [62:03] – Alia Crum’s “mindset matters” research
• [63:03] – Why mindset matters more than tactics or knowledge

Resources and Where to Find Sarah Ann Macklin

• Book Announcement: “Healthy Shouldn’t Be This Hard” – forthcoming, pre-order available (64:45).
• Podcast: “Live Well, Be Well” – in-depth well-being interviews and research discussions (65:01).
• Instagram/Website: @sarahannmacklin; sarahannmacklin.com

Top Five Takeaways (as summarized by Dr. Shah)

[65:41+]

1. Self-compassion is foundational to lasting health; the way you speak to yourself drives your choices and well-being.
2. Stress can mimic or cause illness throughout the body—address the roots, not just symptoms.
3. Nutrition and mental health are deeply intertwined; diet impacts mood, and connection amplifies results.
4. Comparison culture erodes self-worth—self-compassion restores clarity and healthier decision-making.
5. Lasting change requires mindset first, not the “perfect” diet; focus on consistent, nourishing habits.

Tone and Language

Genuine, insightful, and empathetic. Both Dr. Shah and Sarah Ann Macklin speak with warmth, humility, and encouragement, using accessible examples and blending research with lived experience. Their conversation is both practical and hopeful, emphasizing that everyone can start building a foundation of self-worth for lasting change.

For listeners seeking actionable advice, this episode champions starting with empathy for oneself—real, sustainable health change begins in the mind.