If Everyone’s Got Anxiety, Does Anyone Have Anxiety? with Dr. Ellen Vora

Summary

Podcast Summary: Smart Girl Dumb Questions – "If Everyone’s Got Anxiety, Does Anyone Have Anxiety?" with Dr. Ellen Vora

Release Date: July 11, 2025

In this enlightening episode of Smart Girl Dumb Questions, host Nayeema Raza dives deep into the pervasive issue of anxiety in modern society with renowned psychiatrist and author Dr. Ellen Vora. The conversation bridges conventional psychiatry with functional and holistic medicine, offering listeners a comprehensive understanding of anxiety's multifaceted nature.

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1. Understanding Psychiatry vs. Psychology

[00:00 – 04:10]

The episode opens with Nayeema addressing a common misconception: the difference between psychiatrists and psychologists. Dr. Vora clarifies that while both professionals work in mental health, psychiatrists hold MD or DO degrees and can prescribe medication, whereas psychologists typically focus on psychotherapy without the authority to prescribe drugs.

Dr. Ellen Vora [02:09]: "A psychiatrist is an MD or a DO, so they can prescribe medication. A psychologist has more training around the art and science of psychotherapy."

She emphasizes that psychiatrists receive extensive training in anatomical and biochemical aspects of medicine, making them well-equipped to handle cases where medication might be necessary. Conversely, psychologists are often perceived as the go-to for therapy, focusing deeply on psychological modalities.

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2. Functional and Holistic Medicine vs. Conventional Medicine

[04:08 – 09:51]

Transitioning to her unique approach, Dr. Vora explains her integration of functional and holistic medicine into her psychiatric practice. She contrasts this with conventional (allopathic) medicine, highlighting its reactive nature, which effectively addresses acute issues like broken bones or heart attacks but may fall short in managing chronic, subtle imbalances.

Dr. Ellen Vora [05:19]: "Functional medicine is trying to root cause resolution rather than symptom suppression."

Functional medicine seeks to identify and address the underlying causes of health issues rather than merely alleviating symptoms. This philosophy extends to mental health, where Dr. Vora advocates for a whole-body approach, recognizing the interconnectedness of the gut, brain, and overall physical health.

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3. True Anxiety vs. False Anxiety

[14:00 – 19:32]

A significant portion of the discussion revolves around distinguishing between true anxiety and false anxiety. Dr. Vora introduces these concepts, inspired by Julia Ross's work in "The Mood Cure."

Dr. Ellen Vora [14:43]: "False anxiety is a state of physical imbalance that's avoidable. True anxiety is our inner compass nudging us when something in our lives is out of alignment."

False anxiety arises from physical imbalances such as blood sugar crashes, poor sleep, or dehydration, leading to unnecessary stress responses. In contrast, true anxiety serves as an innate signal aligning individuals with their values and unresolved issues, urging them to make necessary life adjustments.

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4. The Importance of Relationships in Mental Health

[19:32 – 21:45]

Emphasizing the human element, Dr. Vora underscores that quality relationships are paramount to happiness and well-being. Citing long-term Harvard studies, she notes that a sense of belonging and strong social connections significantly contribute to mental health.

Dr. Ellen Vora [19:32]: "Human happiness and well-being come down to the quality of our relationships, full stop."

The discussion highlights how modern lifestyles, characterized by isolation and individualism, contribute to increased anxiety and depression, despite the wealth and advancements in society.

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5. Gendered Perspectives on Anxiety

[25:38 – 27:47]

The conversation delves into the gendered nuances of emotional expression. Dr. Vora explains that societal norms permit women to express emotions like worry and anxiety more openly, while men are socialized to display stress and anger.

Dr. Ellen Vora [26:15]: "Women have permission to be worried and anxious. Men have permission to be stressed and angry."

She points out that, biologically, men and women experience anxiety similarly, but the terminology and societal acceptance differ, influencing how individuals seek help and express their emotions.

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6. The Gut-Brain Connection and Neurotransmitters

[34:30 – 37:00]

A pivotal segment focuses on the gut-brain axis, elucidating how gut health profoundly impacts mental health. Dr. Vora explains that the gut produces significant amounts of neurotransmitters like serotonin and GABA, which play crucial roles in regulating mood and anxiety.

Dr. Ellen Vora [35:02]: "GABA is our primary inhibitory neurotransmitter in the central nervous system. It's manufactured by gut bacteria and helps us feel calm."

She emphasizes that maintaining a healthy gut microbiome is essential for producing these neurotransmitters, thereby influencing mental states and reducing anxiety.

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7. Inflammation and Depression

[38:46 – 43:25]

Exploring the cytokine hypothesis of depression, Dr. Vora discusses how chronic inflammation is linked to depressive symptoms. She contrasts this with the traditional monoamine hypothesis, which focuses on neurotransmitter imbalances like serotonin deficiency.

Dr. Ellen Vora [40:23]: "Chronic low-grade inflammation can lead to states that resemble depression, acting as an evolutionary mechanism to promote rest and recovery."

Modern lifestyles, characterized by poor diet, lack of exercise, and persistent stress, contribute to this inflammation, thereby exacerbating mental health issues.

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8. Light Exposure and Circadian Rhythms

[50:22 – 55:38]

The discussion shifts to the impact of modern technology on our circadian rhythms. Dr. Vora explains how exposure to blue spectrum light from screens disrupts the body's natural sleep-wake cycle by suppressing melatonin production.

Dr. Ellen Vora [51:23]: "Blue spectrum light after sunset tricks our brains into thinking it's still daytime, preventing melatonin secretion and disrupting sleep."

She recommends practical solutions like blue light-blocking glasses and increasing exposure to natural sunlight during the day to maintain healthy circadian rhythms and reduce anxiety.

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9. Diet and Blood Sugar Stability

[56:43 – 59:21]

Addressing dietary habits, Dr. Vora highlights the importance of blood sugar stability in managing anxiety. She criticizes the modern diet's reliance on refined carbohydrates and sugars, which cause rapid spikes and crashes in blood sugar levels, triggering stress responses.

Dr. Ellen Vora [57:53]: "Taking a spoonful of almond butter can help stabilize blood sugar without requiring major dietary overhauls."

Simple dietary hacks, such as incorporating healthy fats like almond butter, can aid in maintaining consistent blood sugar levels, thereby mitigating unnecessary anxiety triggers.

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10. Medical Research and Gender Bias

[59:45 – 65:26]

Dr. Vora critiques the gender bias prevalent in medical research, pointing out that women's symptoms and experiences are often overlooked or dismissed. She argues that this bias has led to significant gaps in understanding and treating women's health issues effectively.

Dr. Ellen Vora [62:18]: "We have societal tolerance for female suffering that is different from men, contributing to higher maternal mortality rates and inadequate treatment of women's mental health concerns."

She advocates for more inclusive research practices and greater acknowledgment of anecdotal evidence to bridge these gaps.

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11. AI and the Future of Therapy

[69:46 – 73:14]

In a forward-looking segment, the conversation explores the role of Artificial Intelligence (AI) in therapy. Dr. Vora expresses mixed feelings about AI replacing human therapists, acknowledging AI's potential in providing immediate support but emphasizing the irreplaceable value of human connection and empathy.

Dr. Ellen Vora [71:45]: "AI can do almost everything better, but it cannot offer the physical presence and emotional support that a human therapist provides."

She envisions a future where AI complements, rather than replaces, human therapists, particularly in areas requiring energy work and emotional intimacy.

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12. Concluding Reflections

[74:00 – End]

Wrapping up, Nayeema shares key takeaways from the conversation:

1. Gut-Brain Communication: The intricate dialogue between the gut and brain underscores the importance of holistic health approaches.
2. Societal Influences on Mental Health: The paradox of wealth and innovation coexisting with increasing loneliness and mental health struggles.
3. Scientific Integrity and Public Trust: The need for nuanced, transparent discussions in public health to rebuild trust and address complex health issues effectively.

Dr. Vora reiterates the necessity of self-regulation, community support, and informed decision-making in navigating mental health challenges in today's world.

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Notable Quotes:

• Dr. Ellen Vora [05:19]: "Functional medicine is trying to root cause resolution rather than symptom suppression."
• Dr. Ellen Vora [14:43]: "False anxiety is a state of physical imbalance that's avoidable. True anxiety is our inner compass nudging us when something in our lives is out of alignment."
• Dr. Ellen Vora [62:32]: "Anecdote is actually the base of the pyramid where at the very top, a meta-analysis of several randomized clinical control trials, that's what we consider our gold standard."

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This episode provides a holistic lens through which to view anxiety, integrating physiological, psychological, and societal factors. Dr. Ellen Vora offers actionable insights and underscores the importance of viewing mental health as an interconnected aspect of overall well-being. Whether you're grappling with anxiety yourself or seeking to understand its roots, this conversation is a valuable resource for fostering a more balanced and informed approach to mental health.

Transcript

[Naehymareza]

If you are paying a therapist for 10 years, is the therapy not working?

[Dr. Ellen Vora]

Depends. I think therapists, we always should have in mind making ourselves obsolete and like being so good at what we do that somebody graduates and flies from the nest. But I think that there are times where you play an ongoing role in someone's life and be this container that makes them feel witnessed, understood in the world.

[Naehymareza]

Smart girl, Dumb question. Welcome to Smart Girl, Dumb Questions. I'm Naehymareza and today my questions are around mental health and specifically anxiety. It's estimated that one in five American adults struggle with some kind of anxiety disorder. That's 40 million people. Which begs this question. If everyone seems to have anxiety, does anyone have anxiety and what causes it? Is it physical, mental, the Internet's fault, your mom's fault? And why do we seem to have more anxiety in the United States? Is it something in our proverbial water or the way we live, or just better diagnosis? I have the perfect person to help me answer these questions. Dr. Ellen Vora. She's the author of Anatomy of Anxiety and a board certified psychiatrist who has degrees from places like Yale and Columbia University's College of Medicine. But she also infuses acupuncture and yoga and functional and holistic medicine into her practice. So she's a blend of the kind of more traditional and what some would call the more woo woo. I really love her background and this conversation because it allowed us to talk about everything from kind of how we treat things in conventional medicine to our gut health and functional medicine to this wellness and maha revolution we're seeing. We also talked about how you can tell a good study from a bad study when there are so many contradicting medical studies and whether Dr. Vora and her colleagues are going to be replaced by ChatGPT therapy. Here's my conversation with Ellen Vora. Ellen, thank you so much for doing this.

[Dr. Ellen Vora]

Thanks for having me.

[Naehymareza]

You are a psychiatrist.

[Dr. Ellen Vora]

That's right.

[Naehymareza]

Okay, layman's terms. People are always like, oh, psychiatrist versus psychologist. One of them prescribes medicine and the other can't.

[Dr. Ellen Vora]

Yeah.

[Naehymareza]

Is that the right distinction, you think?

[Dr. Ellen Vora]

Sure. I mean, those terms, this was an emergent phenomenon. Nobody did this on purpose, but they're designed to be confused with each other. And when people confuse and they miscall me a psychologist, they're always like, oh no, did I offend you? It's like, no. And I barely tell the difference between the terms. But a psychiatrist is an MD or a do so they either went to medical school or OSTEOPATHIC medical school, and they can prescribe medication. And theoretically, they've had a lot more education about medical illnesses that can masquerade as mental health issues that can influence how you might tolerate a medication. They have so much more anatomical and physiologic biochemical training that we can prescribe medication. A psychologist. It's not just less training overall, it's much more training around the art and science of psychotherapy, the different disciplines and modality of psychotherapy, and in psychiatry training, we actually don't get a ton of training around psychology.

[Naehymareza]

Oh, wow.

[Dr. Ellen Vora]

So ultimately, if you know you want someone who's going to prescribe meds for you, it needs to be a psychiatrist. But if you think you just want the best darn therapist you can find on the margin, that's probably going to be anybody who's. Who's not a psychiatrist.

[Naehymareza]

Oh, you are so nice. That is such a generous description because you're. You're kind of giving credit more to the psychologist for all the truth.

[Dr. Ellen Vora]

That's the truth, yeah.

[Naehymareza]

Oh, wow.

[Dr. Ellen Vora]

And there are so many psychiatrists that are great therapists, but in general, we have this hierarchy thinking where we think, oh, an md, They've had more training, so it must be better. But it's better for specific things. Is one more expensive, usually a psychiatrist. Oh, interesting. It's a longer training, so you're paying.

[Naehymareza]

More and you might be getting less and less you like the drugs you're getting, in which case you like it.

[Dr. Ellen Vora]

And some people do. They get their meds with a psychiatrist, they get their therapy with a therapist.

[Naehymareza]

Oh, wow, That's a lot of therapy. Okay. That's two more therapists than I have in my life currently. Okay, so you went to medical school.

[Dr. Ellen Vora]

That's right.

[Naehymareza]

At Columbia.

[Dr. Ellen Vora]

That's right.

[Naehymareza]

Okay. And how have you done your psychological training beyond that?

[Dr. Ellen Vora]

Well, while I was still in med school, I took a year off and I did a Doris Duke research fellowship year. That looks so fancy on a resume that was really just that I was burned out. And so I needed a year break from the grueling training process. In that year, I started to go to classes at the psychoanalytic center at Columbia. So that's where I was, like, starting to go down a path of really deepening my skills as a therapist. But I ended up backing back out of that path and going a completely different way with how I practice. What I have doubled down on and strengthened is not actually my skills as a therapist that's come over time, but in terms of trainings I've put so much extra time, money, years, interest, passion into training around functional medicine and Chinese medicine. So I studied Chinese medicine and acupuncture and then I studied functional medicine, which is a very philosophically different way of approaching mental health than my training.

[Naehymareza]

Okay, a lot of terms, Yes, a lot of terms. So we have to get, you know, because this is sgdq. Smart girl, dumb questions. Functional medicine, what is that? And is everything else just dysfunctional?

[Dr. Ellen Vora]

They would have you believe. So the philosophical difference, I think about conventional medicine or allopathic medicine, that's sort of the default western medicine. What we think of when we say you're going to go see your doctor, that's conventional medicine. It is reactive. And that is so good when something really bad has already happened. You broke a bone, you had a heart attack. Thank God for the heroics that conventional medicine can do. The way we react is incredible. And life saving, 90% of what we're actually dealing with in a day to day basis is more of a, we're at a low grade level of how the body is out of balance.

[Naehymareza]

Okay.

[Dr. Ellen Vora]

And that's where that reactive approach is actually not ideal and can sometimes make things worse and can sometimes just leave us feeling like, well, I didn't really get the results I was hoping to get. So we just need the, we need to kind of have granularity in terms of where should you put your energy depending on what's wrong in the body. Things are already bad. Conventional medicine, fantastic things are subtly bad or you're dealing with some kind of chronic illness. Sometimes it's not actually the right place to be. It is the default setting. It's the mainstream. But functional medicine, philosophically, what it's trying to do is root cause resolution rather than symptom suppression. So if you have heartburn in conventional medicine we say you have heartburn. Take a pill and antacid and it'll stop your stomach from making acid and then no more heartburn. Problem solved. Problem. The symptoms have been suppressed. We did nothing to solve why do you have heartburn? Functional medicine comes in and says, why do you have heartburn? And we say, there must be a reason. The body doesn't really make huge mistakes. So there's some kind of imbalance and it starts to investigate increased intra abdominal pressure. Is it obesity, is it pregnancy, is it small intestinal bacterial overgrowth? We identify the underlying root cause, address it at that level and then obviate the need for the antacid in the first place because we've solved the problem. That's the philosophy.

[Naehymareza]

Are there people that find out they are pregnant because they have heartburn?

[Dr. Ellen Vora]

Not typically, but I'm sure it's happened.

[Naehymareza]

Okay. That is a different way than peeing on a stick.

[Dr. Ellen Vora]

Yeah.

[Naehymareza]

I think so much of American medicine, or so much of Western medicine is around that symptom treatment. And you see this right now in kind of conversation around Ozempic. We're treating the symptom of our food supply rather than as a nation kind of dealing with our food supply. And that's not a judgment on Ozempic at all. I know many people who take it and need it, but I'm just. It's. It is the way that we operate in our society, which is. Let's mask the symptom of the thing a lot of the time.

[Dr. Ellen Vora]

Yeah.

[Naehymareza]

Here's a question. Holistic medicine, which is also something that you have on your website. So you're functional and holistic. Again, same question. What is holistic medicine? Is everything else partialistic?

[Dr. Ellen Vora]

So I should probably dedicate some time after I'm done writing my second book to updating my website. But here we are. So holistic medicine, the way I think about it, these terms, we have to keep changing the terms because they take on negative connotation. So I don't know, alternative medicine, they're like, why does it have to be the alternative? Why isn't this the first step, the mainstream? And then it's a complimentary. It's like, why can't it be the main event? And integrative medicine? But that's not exactly what I do. So I call it holistic because functional medicine's still not quite a household term, but that's really what I do. But the idea behind holistic is in conventional medicine, we're really thinking about all the different parts of the body as discrete and separate. It's like if you have something off in your gut, you're going to a gastroenterologist. If you have something off with your mental health, you're seeing a psychiatrist. In my book the Anatomy of Anxiety, there's a line which is your gut and your brain are talking to each other, even if your gastroenterologist and your psychiatrist are not. And all of the Eastern modalities, Chinese medicine, Ayurveda, they're always thinking about the body as these interconnected systems. There's constant, there are no barriers, there's no discrete organs. Everything is in a web of connection. I think that's actually more accurate than. And. And so holistic, to me suggests I'm taking into consideration the whole portrait of someone's health. I'm not thinking I only treat their mental health. What is only their mental health. Their brain is a physical organ influenced by everything happening in their bloodstream. So when I'm thinking about their mental health and thinking about their blood sugar, I'm thinking about how inflamed they are. I'm thinking about whether they have enough vitamin B12 coursing through their blood. So it's to be holistic is to think the whole portrait of someone's life from the minute they wake up to the minute they go to sleep. What are they eating, what are they consuming, what's their community and relationships like? All of that matters.

[Naehymareza]

Okay, so, by the way, I love that all these terms are like having to improve upon each other. And I'm just waiting for someone to open, like Derek Zoolander Hospital for the bestest medicines of all time.

[Dr. Ellen Vora]

I mean, the world has turned into idiocracy increasingly. So these are all possible things. I wear Crocs.

[Naehymareza]

Hopefully shade. Yeah, hopefully shade will not come for that. I think if your doctor wears Crocs, it's time to run.

[Dr. Ellen Vora]

Your surgeon should wear Crocs. Really? You want that guy to be comfortable or woman?

[Naehymareza]

This is so interesting to me because you work in the field of mental health and yet so much of your work, and particularly this book, Anatomy of Anxiety, it's a physical book in a lot of ways. And you're also a person who can prescribe medicine, but your book is kind of arguing, hey, let's take a break from prescribing all this medicine for a second and think about why we're prescribing the medicine and is the medicine right? You're not saying don't prescribe. You're definitely putting guardrails and caution around that.

[Dr. Ellen Vora]

Yeah.

[Naehymareza]

Are you an outlier for your field right now?

[Dr. Ellen Vora]

Yeah, I am. Yeah. And interestingly, I really am not against prescribing medication. Like, I do it. I'm a psychiatrist. I have patients on meds. I do think we're not always judicious about it, but we just lack the imagination of what else can we do. The current treatments that are on the menu, what we're trained to do, it's medication and psychotherapy.

[Naehymareza]

Right.

[Dr. Ellen Vora]

And I just expanded my menu through these additional trainings and so I have a longer menu. But, yeah, mental health is physical health. That's what I really want to cry from the rooftops. Because we think about mental health as a genetic chemical imbalance. We say it's your serotonin, it's. Your serotonin is low. We're looking at it exclusively like the neck up. This is how we're focused on mental health. And we say if you're depressed, if you're anxious, it's because your serotonin is low. So you correct that with a pill. That approach first of all is an improvement from where we came from. We came from more of like a moral shaming understanding of mental health. And we were like, you have depression. And it was kind of, there was stigma around it.

[Naehymareza]

I didn't really know about this term depression. Being Pakistani, growing up in Asia and Africa, I didn't really know about this term until I was kind of in western schools and society and really middle school and then hearing about it from people from Americans mostly. Yeah, it is a kind of western term and there is more of it in the United States. And I've always kind of had this question of are we better at diagnosing it or is there something endemic to the quality of life that we live here that is. Predisposes people to more sadness or you know, like what is, does talking about it make it more.

[Dr. Ellen Vora]

I can hear the argument for all the confounders and yet I truly believe there is something endemic to life here that is conducive to states like depression and anxiety. And it's, it's a broad list of insults. I think it goes everything from the ways that we're isolated to the ways that we're inflamed and undernourished to the ways that we have this individualistic late stage capitalism kind of. We are just not community or other oriented. I think all of this is contributing to the ways that we suffer.

[Naehymareza]

So you're western way of life, despite being the wealthiest way of life, is in some ways undernourished. Both you're saying in terms of our diets, because of the kind of capital drives of our food and also in terms of our society.

[Dr. Ellen Vora]

Yeah, overfed, undernourished, inflamed and lonely and really stuck in a, in a way that we strive and never know contentment. And that doesn't come without some benefits like that American striving. The way we have a fire burning underneath us. We have the iPhone and we have Beyonce because of that. Right. Like we are pushing ourselves.

[Naehymareza]

Everyone likes Beyonce.

[Dr. Ellen Vora]

But, and, but I think that it's maybe at our own, like sometimes our mental health is the collateral damage where we don't allow ourselves contentment and know how to just enjoy a simple life. We are in a. I heard this term recently from a friend of a friend. We're in an existential crisis at all times. It's like, what's next? What's better? How do we scale?

[Naehymareza]

That is the thing. And I mean, when I first, you know, I remember when you wrote this book and you had a big party at the Museum of Ice Cream. Michael Barbaro was there, Esther Perel was there. It was a real fun, fun party. And we all danced and colorful balls afterwards. Yeah, I can do better, actually, during. And I thought, you know, what is anxiety? Like, everybody seems to have anxiety. And if everyone has anxiety. Does anyone have anxiety? Was the kind of burning question. And then reading the book was so interesting to me because what has gone kind of viral out of this book is your understanding of true anxiety versus false anxiety.

[Dr. Ellen Vora]

Yeah.

[Naehymareza]

And I'm sure you got some heat for even putting those labels on the thing. Yeah. Explain what true anxiety is and false anxiety is.

[Dr. Ellen Vora]

Yeah. And that idea of like, if everyone has anxiety, does anyone have anxiety? That's like, smart girl, smart question. And I think that. But I do actually think people have anxiety. And it's. I think that there's a way that culturally, like, we get out of balance in a way of our times. And there's been times in the past where the society would get out of balance toward melancholy. I think right now we're out of balance towards anxiety. Like if you drop a little litmus strip into our waters, the ph is anxiety. That's where we go when we're out of balance. So true and false anxiety. This really credit to Julia Ross, who wrote a book called the Mood Cure. And she identified this concept of a false mood where it's like, you have a true mood, something happened, there's been a death, you lost your job, you're in a mood. As a result, it makes sense. And then there are times when you're just out of the blue, angry, anxious, sad. And if we could really omnisciently look, what we would see under the hood of the body is that there's some state of physical imbalance generating that mood state. So false anxiety, which I do realize now, three years into a book tour is a triggering term. It's not to invalidate the very real suffering of false anxiety. The suffering is so real, it speaks to the fact that it's avoidable, it doesn't need to be happening. And it's not some our essence, it's not our inner compass. It's not an inevitable way that we're reacting. To our circumstances. It's a state of physical imbalance that's false anxiety. Something generated a stress response in the body. It's usually something seemingly benign. It's like a blood sugar crash, bad night of sleep, a hangover. Now we're in a stress response. And we subjectively experience that stress response as anxiety or even panic. And we would do well to identify what was that physical insult, like what got us out of balance and gener the stress response, Address it at that level, and then we can eliminate unnecessary suffering. True anxiety, very much on the other hand, is not something to fix. It's not something to suppress. It's our inner compass. It's nudging us. It's the way our body can communicate to us when it knows we're out of alignment, when we're living out of alignment with our values, when we have unresolved trauma, when we have ongoing socioeconomic stressors, when something needs course correction. And so it's asking us to slow down and pay attention and think, okay, I do actually know that I need to show up in this way and get something back onto its path.

[Naehymareza]

Right? Okay, so just to summarize, false anxiety, it's a symptom of a physical reality that's happening to you, and it's more addressable, let's say, than or targetable than true anxiety, which is this real emotional disalignment in your body that needs to be treated from a mental health perspective.

[Dr. Ellen Vora]

Right. But I think sometimes true anxiety is the inherent fragility of walking this earth in a human body. And so it's really being with uncertainty and impermanence and finding a place where we can be at peace with the fact that this. We fundamentally do not control the outcome of this life.

[Naehymareza]

Does false anxiety ever become true anxiety? Say, you know, you have a bad diet, you are not sleeping well, and that kind of inflammation in your body and is triggering so much activity that over time you're out of alignment with your values. Does that happen?

[Dr. Ellen Vora]

I guess, yeah, I suppose. I haven't really thought about it that way. I think that if you are making all these modifications to your life, like often with anxiety, people make their lives smaller and they are saying, well, I get anxious on the subway, so I just won't take a subway, Or I get anxious on planes, so I'm just not going to go to my friend's wedding, Or I'm not going to visit my parents, even though I haven't seen them in a while. So people make their lives smaller. And I suppose I haven't I think it's really astute is that sometimes then you're out of alignment because you really should be visiting your parents. And so.

[Naehymareza]

Yeah.

[Dr. Ellen Vora]

And that can feel uneasy in a way. That is your inner compass nudging you and saying, this isn't right.

[Naehymareza]

Yeah. I think I don't want to take away any therapy business, but I sometimes feel like the best thing is like just visiting someone who loves you and getting a big, big hug and you're like, that is the best thing you can do when your body feels out of whack or the best thing I can do.

[Dr. Ellen Vora]

I mean, this is in our hardwiring and we know from that long term study out of Harvard that human happiness and well being comes down to the quality of our relationships full stop. But that's because on that savannah of human evolution, we were not particularly fast. We weren't the strongest species. We figured out how to cooperate.

[Naehymareza]

Right.

[Dr. Ellen Vora]

It's really for that reason that it's hardwired in us. When we feel a sense of belonging and connection, we feel safe. And when we feel disconnected, isolated, ostracized, our DNA is screaming like, we're not okay.

[Naehymareza]

Right.

[Dr. Ellen Vora]

And so we are social creatures. There's no way around that. And that actually needs to be our highest priority. And so it is a form of true anxiety. But yeah, it needs to be addressed.

[Naehymareza]

It's so sad because right now we feel like less cooperative as a society than here than I think a lot of or anytime in my recent memory history. Yes. There's this idea that worry happens in your mind, stress happens in your body, and anxiety is the culmination of that whole physiological activity. This is from a 2020 New York Times article. Have you read that article?

[Dr. Ellen Vora]

I haven't read that article. I probably should have. Maybe I did.

[Naehymareza]

No, I mean probably in 2020 it was like. And people were like, oh, that's so good because now I can name it. Stress is this physical thing, worry is this mental thing. Anxiety is like the everything.

[Dr. Ellen Vora]

Right.

[Naehymareza]

Is that accurate?

[Dr. Ellen Vora]

Here's like my pet peeve in, in this corner of life is that. And I get it. Like when I was in med school and I was really not happy, I came across a term dysthymia. And it was like, you're not, you don't have major depression, but things are not okay. You have dysthymias, chronic low grade depression. And like dysthymias.

[Naehymareza]

Dystopian.

[Dr. Ellen Vora]

Y m I a just Miami. Yeah. And I was like, there's a word for what I have And I found that to be so grounding and so helpful. And I know this with patients, like when you say you have high functioning depression or it turns out you have bipolar too. You know, like we all latch onto a term and it's helpful and it's grounding. But I actually am so much more interested at this point in my career of like, well, does that help us know what we do about it? Like, does that change management or is that just like the, the comfort in naming? And to me that kind of conception of like worry in the head and it's like, that's, that is really interesting to think through. Like, oh, like this is worry, this is up here. But unless it tells me like, what are we doing to bring someone relief? I'm like a little bit less, I don't obsess over it. Like what I'm seeing probably differently than the New York Times article is like what we're calling stress in the body, I'm actually saying is physical imbalance in the body. And yes, let's address that. Because if the equation is worry plus stress equals the quantity of anxiety they're feeling, if we can reduce any of that, we're relieving some degree of their anxiety.

[Naehymareza]

Right. And I don't necessarily know that that was the point of the article. They had, they had something in it which was like anxiety in some ways is a response to a false alarm.

[Dr. Ellen Vora]

Yeah.

[Naehymareza]

Which is something that is actually similar to what you're arguing. But there's also another term beyond worry, stress, anxiety. And I think it's actually the term of our moment which is spir.

[Dr. Ellen Vora]

Yeah.

[Naehymareza]

What is spiraling to you?

[Dr. Ellen Vora]

What I think about when I hear that term, like I have a 9 year old daughter and it feels like in our day to day life right now is the opportunity to help her learn skills to not spiral later in her life. And it's almost like, do we have the ability to take a beat, catch our breath, ground self, soothe, regulate our nervous system and, and approach a problem methodically with some degree of calm rather than 0 to 60. And somehow as a society, and I really don't mean this in like a blamey, shamey way, there's no individual to blame here. We, we all just collectively arrived at this point where we lack that skill set. And so we spiral. We go 0 to 60 and somewhere in our development we miss the like. Hold on a second. I know for me I was a spiraler and it was through my 20s that I got into yoga where I learned how to not spiral. And I think it was those moments when I'd be like holding plank pose or holding Warrior 2. My muscles would be shaking and the instructor would be like, breathe and find equanimity. And I'd be like, why do you keep talking? Take us out of Warrior 2. I'm so uncomfortable right now. I'd be spiraling if that was my nature. And, and in that, very calming. But they kept reminding you, like that slow diaphragmatic breathing. Can you find equanimity even in the face of challenge? And I think over like the 10,000 hours of that process, I learned that skill. And I'm hoping I can impart that on my daughter. I'm hoping culturally, when we're, we don't seem to be, we're getting worse before we get better with this. But we all want the ability to. How do we find calm in our nervous system so that we can say, okay, what's happening here? In more of a mindfulness sense. Like rather than 0 to 60, I'm triggered, they're wrong, I'm right, this is bad, I'm spiraling, I'm panicking. It's more of like a what's really happening here? And can we hue more closely to compassion, to understanding, to recognizing what might be triggering us? And I do think there's a role for the physical body in changing our threshold for spiraling.

[Naehymareza]

I think spiraling is something very particular to social media. Almost like for me, there's something between spiral and doom scroll or scrolling that's linked and it's this kind of like what you're saying, going zero to 60, all of a sudden you're at such speed and you're just like going around and around and around and around the same topic. Like, you know, and I have found that the best thing for me when I see myself spiraling about something that's a personal crisis, something that's like a professional reality, something that is happening in the news. As a journalist, you know, you find yourself just like emotionally caught up in something is like I just will go and do 20 pushups and being in my body is the best way for me to get the fuck out of my head.

[Dr. Ellen Vora]

Yeah. Even if you just think about it energetically, spiraling has this quality of like you're like a cartoon where like the energy is spiraling up. And when we can come back into our body, whether it's through pushups, dance, music, going outside, splashing cold water in our face, doing a non sleep, deep relaxation exercise, full body scan, all of those things, we come back into our body, and that does help bring the energy down, and we don't spiral as much. And I think you're exactly right. Social media plays a role. Character limits. We literally don't have space for nuance anymore, and we're now accustomed to communicating in character limits, if not even just emojis. So there's no more nuance. And that's contributed to the way we're hyperpolarized and we no longer hold. Two things can be true. Mm.

[Naehymareza]

I wanna come back to your whole argument around anxiety and really the role of inflammation and physicality in that anxiety in our society. Before we do that, I just wanna ask you, because when I read that Times article in 2020, I did think these terms are so gendered. Like, worry is a mental thing, and it's really associated with women. Historically, stress is like, what men tell you. Men rarely say, oh, I'm worried, Dads do. But men usually are like, I'm stressed about my job.

[Dr. Ellen Vora]

Yeah.

[Naehymareza]

I'm not worried about losing my job. No, no, I'm not worried. I'm stressed about it. And then anxiety, I think, has had a more feminine connotation in our culture.

[Dr. Ellen Vora]

That's right.

[Naehymareza]

Does either gender experience anxiety at higher volumes?

[Dr. Ellen Vora]

So I think that's exactly right. And I think that this has so much to do also with, like, what do we have permission to feel in a particular gender? And women have permission to be worried and to be anxious. Men have permission to be stressed and to be angry in ways that we don't. And I think that. So, yeah, we latch on to the term that is still allowable and maintains our relationships and social standing. But I think that, like, a more conventionally minded psychiatrist would be saying, but we're all feeling anxiety like, that There isn't that much difference between a man and a woman in terms of they're feeling it. It's just different in what they're calling it. So they might say, well, that guy, he has anxiety. He doesn't know it, he's just drinking, or he's just, you know, it's being expressed as anger.

[Naehymareza]

Right.

[Dr. Ellen Vora]

I'm, like, less interested even in the semantics of, like, what are we calling it? I'm very interested in what is someone subjectively identifying with. Like, if they're saying, I'm stressed, let's work with that. They're saying, I'm anxious, let's work with that. To me, those terms are very important for clinical research. Like, we need standardization, and whether or not someone meets criteria for a diagnosis is really important. If we want to gatekeeper interventions that have risk.

[Naehymareza]

Right.

[Dr. Ellen Vora]

But most of what I'm doing, all of that is somewhat immaterial. And it's like, okay, you feel stressed, you feel anxious, I don't really care. It kind of points us in some directions, but ultimately I'm going to roll up my sleeves and do the investigative work of, like, what's out of balance here? Let's address that.

[Naehymareza]

Imagine, like a very nuanced world where we're maybe heading with AI, where it's like, no, no, I'm not depressed. I have dysthymia. Oh, no, no, I'm not anxious. I have whatever. Right. False. I mean, I could imagine that this is where we're trending, right? Anyways, we' a quick break for Sponsored Dumb Question from noom, and we'll be right back to hear more about anxiety and how we can curb it. Are women more hormonal than men? I'm Naeema Raza, host of Smart Girl Dumb Questions, and this is the Sponsored Dumb Question brought to you by noom. Calling women crazy is as old as ancient Greece. In fact, the word hysteria actually comes from the Greek word istara or uterus, because those ancient Greek dudes thought that women's uteruses would, like, move around their body and make them act, well, crazy. It's kind of like these days when a girlfriend's bad mood is dismissed as her PMSing, or your mom blames her hot flashes for her grumpiness. The truth is, there are all kinds of rational reasons to be upset. And no, women's uteruses do not move around their bodies. But as women, our hormones do fluctuate throughout our menstrual cycle. And both men and women see their hormones fluctuate with age, particularly around puberty and again in middle age. As women approach menopause, declining levels of estrogen, progesterone, and testosterone mean that they'll see all kinds of unwanted symptoms, from sleeplessness to muscle loss, from weight gain to, yes, mood swings. To help manage those difficult symptoms, women can benefit from hormone replacement therapy, or hrt, which NOOM now offers as a way to help women feel great at every stage of their life. And NOOM plus HRT means faster, more sustainable results, particularly when it comes to that stubborn, unwanted weight gain around menopause. See, it's not crazy. To learn more, visit noom.com menopause so anxiety and the anatomy of anxiety. This begs the question of, like, for me, what moves faster, our brain or our body? When we're feeling something, do you know the answer to that.

[Dr. Ellen Vora]

Whoa, okay, what moves faster?

[Naehymareza]

Like where do we feel it first? Because as you're saying like you're, you know, mental health has always been like the neck up.

[Dr. Ellen Vora]

Yeah. But I'm going to concretely answer that question to the best of my knowledge. But then I'm going to kind of philosophically deconstruct it a little bit.

[Naehymareza]

I love a little philosophical instruction after a mid roll break.

[Dr. Ellen Vora]

So I think that like reflexes are the body moving faster than the brain. Like a reflex is you take your hand away from the stove or like even like knocking the knee that is going up your spinal cord and right back down without ever involving the cerebral cortex, without ever involving like, oh, should I take my hand away from the hot stove? Like it's happening in a way that's much faster than cogitation. And so sometimes the body moves faster. Sometimes I feel like my thoughts move too fast. But I think that my philosophical deconstruction of that question is that like whenever I'm coming onto any, any kind of speaking engagement it's like ah, like her approach to mental health is that it's like the mind body connection, like that it's more physical. Anxiety is more physical than we think. And usually how it's thought of is oh, like the way some people's anxiety manifests as IBS for. Some people's anxiety manifests as these physical symptoms, tension or something, or you're breathing differently. And that's all valid and something to expl and unpack. But I'm really actually interested in the other direction of traffic, which is that we're experiencing something we call anxiety. We subjectively feel as anxiety, but the root of it is physical imbalance. It's not that the anxiety has created physical symptoms, also true. But the part where I'm like, where do we change someone's life? Where do we bring them relief? Is not in being like, let's fix your anxiety so that we can fix your ibs. That's hard to do. Let's heal your gut so that you're not anxious anymore at all. And so it's really starting with the physical body and understanding all the mechanisms for how physical imbalance generates states that we call mental health conditions. And so it's really just thinking, where is the physical body out of balance? Let's start right there.

[Naehymareza]

That makes a lot of sense to me and that's very much how I read your book. It's like this idea of the neck up the serotonin analysis and then you know, prescribing SSRIs to deal with. What's the head? Well, I think I hear two things in what you're saying. One, your head is part of your body.

[Dr. Ellen Vora]

Yes.

[Naehymareza]

Like, that's what you said at the very top. Your brain is actually part of your physical reality. So there's that. And two, it's also tied to everything else in your body, whether that's, you know, whether that's your gut, whether that's your. Your exercise levels, everything. You know that serotonin comes from somewhere. Right.

[Dr. Ellen Vora]

It's downstream.

[Naehymareza]

Right.

[Dr. Ellen Vora]

And I think that when we're, like, looking at, like, can we nudge the serotonin behavior in the brain? Can we as even actually we can nudge it, does that bring us effective antidepressant effect? It looks like in severe depression, yes, to some degree. In mild to moderate depression, it's a little bit equivocal. And basically that it doesn't seem to separate from placebo. Mark Horowitz had a paper in molecular psychiatry in 2022 that was like, there is actually no basis for the serotonin theory of depression, which is very upsetting for anyone who's benefiting from their meds. So I always want to follow that quickly by saying, if you're benefiting from your meds, you're benefiting from your meds, even if serotonin isn't the direct mechanism. And it's not even just to say the mechanism is only the placebo effect. It's to say, we might not understand the mechanism, but if you're helped, great.

[Naehymareza]

But not everyone will be helped.

[Dr. Ellen Vora]

But not everyone will be helped. And we might do well to step back and say, should we start investigating other mechanisms? And so I think that, yes, the gut is involved in many mechanisms that impact the brain. And so it's more than serotonin. And nudging the serotonin is the most downstream place we can look. It's like we're looking at the very tip of the branch of the tree. Maybe we actually want to take better care of the soil that's surrounding the roots of the tree.

[Naehymareza]

Right. And the soil in this case is like your mother and your boyfriend. I'm kidding. The soil in this case is like your diet and your exercise, all of it.

[Dr. Ellen Vora]

It's holistic.

[Naehymareza]

Okay, so let's talk about the gut, because I feel like the gut is so. I mean, everybody's talking about the gut, kimchi, et cetera. I feel it's a little out of fashion. Like, everybody was talking about the Gut two years ago. And now everyone's talking about creatine and muscle, like they've moved on from gut. But I feel like the gut is still important. And certainly when it comes to those eastern modalities. And so much of Ayurvedic medicine, 5000 years of South Asian medicine, is around this idea of like, ghee, butter, your gut, your diet.

[Dr. Ellen Vora]

Yeah.

[Naehymareza]

And that not everybody should have the same thing. It depends on your physicality. So the gut has a react. Like when we say gut reaction, does that mean anything to you?

[Dr. Ellen Vora]

Yeah.

[Naehymareza]

What does it mean?

[Dr. Ellen Vora]

It means that culturally, linguistically, we come up with all these terms that are a reflection of what's. What's really happening there, what we're feeling. Like long before we know the science, we. We do have a kind of knowing in our gut. It's interesting the way we're ten to one gut microbes to our own cells. So, like, this is a very.

[Naehymareza]

There are 10 times more gut microbes than there are human cells.

[Dr. Ellen Vora]

That's what we estimate.

[Naehymareza]

Okay. Oh, wow.

[Dr. Ellen Vora]

Yeah. And I mean, I think that the centrality of the. Of the gut and its importance to our health, like our body hasn't moved on from that, even though social media has.

[Naehymareza]

Yeah.

[Dr. Ellen Vora]

And. And it is central.

[Naehymareza]

It's out of fashion. It's the interior gut.

[Dr. Ellen Vora]

These guys, I'm all for protein and muscle. Like that matters too. Um, it. It all matters. And I think that with the gut, there are just certain mechanisms that are important to understand, which is that the gut is not only where we're manufacturing certain neurotransmitters like serotonin, like gaba. We don't usually talk about gaba.

[Naehymareza]

Gaba?

[Dr. Ellen Vora]

Gamma aminobutyric acid.

[Naehymareza]

It sounds like a, like band, like gaba.

[Dr. Ellen Vora]

Yeah, right. That would be gaba. And they just sing like lullabies. But GABA is our primary inhibitory neurotransmitter in the central nervous system. Translated to English, GABA is what makes us feel calm and like we're going to be okay. And so gaba, I think, is an endangered species in modern life. It's also manufactured by certain microbes, interestingly, in the gut. And so when our gut is healthy, we're making neurotransmitters. We are training the immune system. The immune system does most of its basic training in the gut, and it's learning to differentiate between friend and foe based on this ecosystem of fungi and bacteria and even parasites and viruses that live in our gut. So when our gut flora has been decimated by antibiotics or Just a lack of kimchi in our diet, then our immune system is lacking that basic training, and it tends to not perform in such a calibrated way.

[Naehymareza]

And gaba, Sorry, GABA is like a measurable thing. It's like a type of microbe.

[Dr. Ellen Vora]

No, GABA is a neurotransmitter. When we talk about serotonin, that's another neurotransmitter, dopamine. Those get a lot of. They're in the limelight. But GABA matters quite a lot. And that's manufactured by gut bacteria in the gut.

[Naehymareza]

And neurotransmitters are things that, in your body that talk to your brain.

[Dr. Ellen Vora]

Yeah, they're chemical messengers. They are the things that, when two neurons, two brain cells talk to each other, they can talk to each other in a few different ways, but one of the primary ways that they talk to each other is by spitting a neurotransmitter out from the end of one neuron to the next neuron. That's how they talk. And they can say, like, green light, red light, and red light sounds bad, but red light feels good. Like a brain that is full of excitatory signals and like, go, go, go. That's kind of a state of agitation or even like muscle twitching. A calm system has a lot of inhibitory signals. It's a lot of what the way the brain functions. Well, is not saying yes to something. It's actually appropriately saying no, so that we can choose one path and do that with clarity and focus.

[Naehymareza]

And how are neurotransmitters different to hormones?

[Dr. Ellen Vora]

Hormones are happening in the bloodstream, circulating and communicating to organs all over the body. And there's overlap in all of this, but neurotransmitters are more associated with. This is how our neurons in our brain are talking to each other. Brain and spinal cord.

[Naehymareza]

Interesting. And so. And you talk about the gut body connection a lot in this book because you have seen many patients where their anxiety is actually a response to something that's happening in their gut. Something that's happening either antibiotics, over prescription, or diet. Is that correct? Yeah. And I love that sentence that you'd said where it's like, regardless of whether your endocrinologist and your psychiatrists are talking to each other, your gut and your brain are definitely talking to each other. And now it makes sense, because now I understand what neurotransmitters really are. So inflammation is, like, at the root of all of this. And you have this concept in your book. I have to look it up because I can't pronounce it.

[Dr. Ellen Vora]

It's like the psychotine cytokine hypothesis of depression.

[Naehymareza]

Say it again.

[Dr. Ellen Vora]

Cytokine hypothesis of depression.

[Naehymareza]

Yeah. So. And it relates also to inflammation.

[Dr. Ellen Vora]

Yeah. And it's not the root of everyone's depression, but it's the root of some people's depression. Like what we've been talking about with serotonin. That's the monoamine hypothesis of depression. Serotonin, the type of neurotransmitter it is, is called monoamine. So we say monoamine hypothesis of depression. The one that says it's your seroton. That is one of many possible narratives to make sense of depression. It's not even our most evidence based one. It's just the one that happens to be. The current consensus is our treatments are based on it. It's kind of derived from tuberculosis drugs that modulated serotonin and made some people feel less depressed. So we've been laser focused on serotonin for decades and to varying degrees of relief from people's depression. A competing hypothesis is the inflammatory cytokine hypothesis of depression. And it basically shows us that for some people, their depression correlates with the degree to which they have cytokines, these inflammatory molecules coursing through their bloodstream. And it stands to reason. This one's interesting because I always like an ancestral or evolutionary explanation for like, why would this create depression? So if you're on that proverbial savannah and you made the mistake of drinking from the wrong pond and you got a weird microbe, your body is thrown. State of acute inflammation. What makes sense under those circumstances is to retreat to your cave. You might be contagious, you don't want to infect the rest of the tribe, you want to go rest in the dark. Because those are the conditions under which your immune system has the best shot of keeping you alive.

[Naehymareza]

Resting in the dark.

[Dr. Ellen Vora]

Resting in the dark, having changes in your appetite, socially isolating. And that works for your body. Fighting off an infection that actually happens to look a little bit like what we would call depression. It's the sick response. You want to retreat, you want to be resting. You have low vitality, you have appetite changes, you're fatigued, you feel malaise, you don't want to socially interact. And so the theory is that a lot of people are in a state of chronic low grade depression because they're in a state of chronic low grade inflammation. And who among us is not in some degree of inflammation in modern life? Because the modern environment makes a broad assault against both inflammatory, provocative Pro inflammatory insults, like foods that we're eating and exposures that we have, but also because our gut is so compromised that we're not properly calibrating our immune system.

[Naehymareza]

I love that you call it insults, like stuff that we do to ourselves. But it's an insult what you put in your body, how you treat your body, whether you're on the phone all night and seeing that kind of blue light before bed. So if inflammation is the root of a lot of bad stuff in our body and our brains and our anxiety or depression, how do we know if we're inflamed or not?

[Dr. Ellen Vora]

So there are blood tests and you're probably not getting those blood tests. If you're just like walking into your primary care doc in a conventional setting. If you're seeing a functional medicine doctor, if you're seeing a naturopath, they may be testing for it.

[Naehymareza]

What are the specific things that you should do?

[Dr. Ellen Vora]

So some starter ones are something called high sensitivity CRP or hscrp. That's a very good screener for inflammation. Sometimes you want to look at homocysteine levels. Sometimes you're going to do a much more involved panel looking at specific cytokines. But typically CRP is a really good place to start.

[Naehymareza]

Okay. And those are not the regular, like when you're going in our cholesterol or blood sugar, et cetera, are those secondary measures? Like, if we had an inflamed response, would we see that in the more traditional, conventional, you know, partialistic dysfunctional medicine?

[Dr. Ellen Vora]

Usually. And I thought of one other as the sed rate, which is esr. And usually the way a conventional doc is going to be checking for inflammation would only catch if you are in that moment acutely inflamed. Like you might have high white blood cell count. And so this more subtle, low grade background chronic inflammation is usually not going to get picked up by the complete blood count and like basic metabolic profile that you're going to get with a conventional doc.

[Naehymareza]

I don't think we're good at like naming our feelings. I have one more question in that, which is nowadays we're teaching kids like color wheels for their feelings. I see this with, my God kids. They're like, they feel blue or green. Green is good. Yellow, which is like murky, red is like angry and blue is like down. Do you, have you seen this color wheel? Yeah, yeah. I feel like that's actually kind of helpful. There's also this Finnish study that I sent you done 10 years ago where they looked at, I think, thousands of People, they looked at people and they asked them to say what they were feeling and where they were feeling it in their body. I found that fascinating.

[Dr. Ellen Vora]

Yeah. To me, what's most fascinating about that is the universality of it, that it doesn't matter. It's not about like culturally learned phrases of like, I have a broken heart or you know, like, I got cold feet from this. It's that there's something universal about where we feel different emotions.

[Naehymareza]

Yeah.

[Dr. Ellen Vora]

I think the color wheels are great because we are in this emotion phobic culture. We absolutely lack granularity in how we talk about our feelings. The work of Brene Brown in her Atlas of the Heart, she talked about how most people can only name like three emotions. I think it's like, like happy, sad, angry.

[Naehymareza]

How many emotions are there?

[Dr. Ellen Vora]

I don't know, it's like 72 or something. And. And I think that Mark Brackett, his book Permission to Feel is also a beautiful approach to this. And I think that the more granularity we have is really powerful, partly because, as we discussed, naming is very grounding and helpful, but also because we do confuse certain states. We're more. We have more of a tendency to say that something's negative when in fact it's not negative. It's just activated.

[Naehymareza]

Right.

[Dr. Ellen Vora]

So if you're about to, like, I was at school drop off this morning talking to a family and they're moving to like across the ocean. And this seven year old boy, everyone was like, are you excited? Are you excited? And what he was struggling to try to articulate as a seven year old was, I'm ambivalent. Like, he's excited and scared and there's a lot to look forward to and there's a lot to mourn. And that's just it. So his response is just like. But you can see in his eyes ambivalence. And so of course, because, of course. And so we need the granularity because when we're too simplified about it, we're gonna bias negative and then we're gonna move from that place.

[Naehymareza]

Right.

[Dr. Ellen Vora]

And I think that actually causes some of our problems in relationships especially.

[Naehymareza]

It was interesting to read the study because it's like, oh, a lot of the negative emotions are happening in your chest up. They're like you feel chest tightness. And that could be you're sad, you're depressed. If you're angry, you feel it in your limbs, often in your arms, which is amazing. Like, it's kind of like, you see sometimes like men get angry and they roll up their sleeves or they like kind of, you know, and there's a sense. And then the limbs are also where you feel love, like weakness in your limbs. That can come from love or can come from sadness. I thought that was such an interesting to your point. Like I don't know, were you surprised by this?

[Dr. Ellen Vora]

No. And like, and happiness is the whole body. And like I think there was something about fear, anxiety, like that your limbs go numb, you feel powerless. But I think Two Way street is always a really interesting way to approach any of this. And a lot of those anger responses, they're just this hardwired stress response that we have. We're angry and deep down in our wiring, it's like you might need to fight somebody right now. So we get tense in all the ways that make us best able to run and fight. We get focused, our pupils dilate, we get tense in this area. We even like er, like tense in our jaws because that's part of how you show dominance is like that, you know, picture a dog growling. It's like er, you're trying to actually ward off and assert dominance so the other opponent decides to flee instead of fight you.

[Naehymareza]

Right.

[Dr. Ellen Vora]

And I think that what's always worth looking at is how does modern life get our body just by happenstance, stuck in a state that tells our brain we're about to fight? Ah, because when we're staring at the phone, when we are looking at the computer and our eyes are bulging, like a lot of this is part of a reciprocal communication between the body and the brain that says we're in a fight or flight situation. Sometimes it's, we actually aren't. We just have jaw pain because we have a narrow palate and we're breathing through our mouth while we sleep. But it leaves us in a state of chronic stress. So you want to address it at that level and really figure out how can we not have TMJ so that we don't feel so anxious as a result. Where I think we can find relief in a pretty realistic actionable way is preventing our body from getting tipped into a fight or flight response unnecessarily. That's my interest. Because if you're genuinely in a threat, this is wonderful that we have a fight or flight response. If you are underslept because you're up doom scrolling hungover, you had an extra cold brew coffee, you skipped breakfast, your blood sugar's crashing, you're in a fight or flight response and it's kind of dumb. That's so much suffering and it doesn't need to be happening. And I'm not saying we should all lead perfectly virtuous lives, but there's small strategic shifts we can make that eliminates so much unnecessary fight or flight from our lives.

[Naehymareza]

You're basically saying, like, increase your tolerance so that not everything is activating your flight or flight response in some way.

[Dr. Ellen Vora]

Sometimes it's increase your tolerance, and sometimes it's.

[Naehymareza]

Or like, raise your bar. For what?

[Dr. Ellen Vora]

Yeah, it is sometimes that and it. But it's sometimes not even. I mean, like, some of these things are about changing the threshold for your body getting tipped into a fight or flight response. But sometimes it's really just don't have a blood sugar crash, then no fight or flight response. Like, keep your blood sugar stable.

[Naehymareza]

But in your argument, it's like the blood sugar actually, like, increases, like, makes everything your body trigger triggered to have a primal fight or flight response.

[Dr. Ellen Vora]

Exactly. Yeah.

[Naehymareza]

Sometimes I think, like, living in New York is like a great antidote to this because there's so many stimuli that you just kind of have to walk through New York. Like, I still. I've been here for six years, and I still have this sensation, like, when people are like, get the fuck out of the bike lane. And I'm like, I love living in New York. I feel like I'm in a movie.

[Dr. Ellen Vora]

You know, like, it's helping my anxiety.

[Naehymareza]

Yeah, exactly. In some way, like, it, like, raises my bar for everything because I'm like, there's so much happening.

[Dr. Ellen Vora]

There's the beauty of the human body and how we acclimate to sensory information. Like, if I go away and then come back to New York, I'm like, it's very loud here, right? But then a day and a half later, I'm like, it's normal. Yeah, it is a little bit. I think it is still a little subtly hard on our nervous system to be here.

[Naehymareza]

Is Western medicine just trying to, like, perfect something that has existed for thousands of years or perfect or pharmaceuticalize something that's existed for so long?

[Dr. Ellen Vora]

Well, is the suggestion there that, like, anxiety is normal and we're trying to, like, remove the bumps from the road of life?

[Naehymareza]

I don't know. I just feel like there's so much that we're, like, recreating in the west that, like, exists. Like, are we good at learning from what else is out there?

[Dr. Ellen Vora]

No, we're not. But here's what I really think is that I think the human body is decently well designed, with the exceptions of the knee joint and menopause. It's Decently good design.

[Naehymareza]

Yeah.

[Dr. Ellen Vora]

And so what happens is that we are living in a way that's so different. If you map human evolution, we were living in a way. I'm not saying it was easy. We didn't have hot showers and we had infant mortality and a lot of badness. But there was a certain set of inputs to our system for millennia. And then here we are, and the last sliver of time, we have like Doritos and blue spectrum light after sunset. And so the springs are popping out of the machine. And it has to do with subtle aspects of modern life that we just didn't evolve to be okay with.

[Naehymareza]

Right.

[Dr. Ellen Vora]

And so I think a lot of what Western medicine is doing is saying, like, there's all these problems, let's patch it up. And sometimes I think the more elegant solution is to not have the problems in the first place by recognizing where are we giving the machine the wrong inputs.

[Naehymareza]

Yeah. And this is a question I have, because I have heard this argument from many people that like, light is really. Electricity is really what fucked us. It's all, you know, Thomas Edison's, Franklin's fault or something. But the idea being that, you know, when we used to live and die by the sun, or live and sleep by the sun, eaten sleep by the sun, our bodies were much more regulated. So how is technology kind of changed everything?

[Dr. Ellen Vora]

Yeah, I mean, this whole system has to have a 24 hour clock. And our internal clock, it's called the suprachiasmatic nucleus in the brain. How does it know when it's daytime and nighttime? It's not connected to a cell tower. That's not where it gets its information. It's connected to our eyeballs. And so the way it tells us.

[Naehymareza]

Neurotransmitters, it actually is directly like just.

[Dr. Ellen Vora]

Neurons straight from our eyeballs are going to the super chiasmatic nucleus and, and saying, hey, there's light hitting or there isn't light hitting. And so it's telling our brain whether it's daytime or nighttime. And that system was foolproof. And it helped us be awake during the day and tired at night. And I don't blame evolution for not anticipating this plot twist, which is that we were going to harness electricity and then invent the light bulb and eventually White Lotus, and nobody was going to sleep anymore. That's where we are, is that we have blue spectrum light, the light that resembles the daytime sky coming into our eyeballs long after sunset. Whereas we evolved seeing fire and moonlight. And so our bodies are like, we have a lot of different drives for sleep. We have fatigue, we have sleep drive. There's adenosine, there's all this going into it. But ultimately it's saying, I sure am tired, but I can't argue with the sun being out. So that must mean it's daytime. We suppress our melatonin, we secrete cortisol, we feel awake and then we don't sleep. And then that gets everything else out of balance. So just getting strategic about what kind of light is coming into our eyes during the day and at night goes a long way.

[Naehymareza]

Okay, and you have, you, you suggest to have these blue light inhibiting glasses.

[Dr. Ellen Vora]

Can we put them on? We can put them on. Let's, let's, let's model this.

[Naehymareza]

They're not very sexy.

[Dr. Ellen Vora]

I will say they're very sexy.

[Naehymareza]

You took the sexy ones for yourself and you gave me.

[Dr. Ellen Vora]

Those look extraordinary. Ready?

[Naehymareza]

These look very. This looks like I'm going to go into a sixth grade science experiment with a beaker or something.

[Dr. Ellen Vora]

And I think, like where we want to get strategic about light cues, it's first thing in the morning and it's after sunset first thing in the morning. You just want to somehow, some way get actual sunshine into your actual eyeballs. Not through sunglasses, not through a car windshield, not through a window. The real thing. But that tells your body this is morning. It stamps that moment in time and not only makes you feel awake during the day, but ticks in the background. Program your brain to get tired at night.

[Naehymareza]

Okay?

[Dr. Ellen Vora]

And then after sunset, that's the real secret sauce. Because that's what's most disparate from the conditions under which we evolve.

[Naehymareza]

So in the morning, get up and get outside. Not through a window, not do anything. Just like be outside.

[Dr. Ellen Vora]

Even if it's just a couple minutes. It doesn't have to be The Andrew Huberman 20 minutes along the Pacific coast, 30 if it's overcast, it can be a couple minutes. That makes a difference.

[Naehymareza]

Let your eyes show the brain the sun, even if there's no sun, even if it's a rainy day.

[Dr. Ellen Vora]

Outdoor daylight, even on an overcast gray day is so much brighter than anything indoors.

[Naehymareza]

Okay. And then at nighttime, after sunset, if you don't have a date, put on these glasses.

[Dr. Ellen Vora]

The solution is really to move off the grid and raise chickens and make sauerkraut and defenestrate your phone deep into the ocean. If that's not available to you in the next week or two. This is the harm reduction strategy.

[Naehymareza]

How long do you have to wear these?

[Dr. Ellen Vora]

What I do Is I own two kinds. I own.

[Naehymareza]

Yeah, the less sexy kind and the less sexy kind.

[Dr. Ellen Vora]

Yeah, more and less sexy. And the more sexy are. Actually, they just look like glasses. I use the gooder ones. They're 25 and they just look like glasses. But they have blue blocking lenses. I put those on at sunset. I wear them and then as it gets closer to bedtime, I switch to these. And that way I am blocking blue spectrum light from getting into the eyes. Everyone's like, what if I just put night mode or night shift mode on my devices? Flux on the computer. Those are all great. They're necessary, not sufficient.

[Naehymareza]

Got it.

[Dr. Ellen Vora]

So it's wonderful to dim and orangify your screens. It's still going to be blue spectrum light. So blocking it is still helpful to produce melatonin as you get tired.

[Naehymareza]

What I've done is turn my phone into black and white. And that is amazing. It makes the phone so unsexy. Like, so I'm so uninterested in spending time with my phone on black and white.

[Dr. Ellen Vora]

It's like next to raw. Dogging a flight, it's really hard to do, but I'm glad you do it.

[Naehymareza]

Yeah. It tells you why, like, the newspaper business is struggling. You're like, oh, this?

[Dr. Ellen Vora]

They just need more glossy.

[Naehymareza]

Not exciting. Exactly. Okay, so you're saying, like, back in the day, there were no night owls, like, in the year 100 BC?

[Dr. Ellen Vora]

Oh, I think there absolutely were night owls. I think that we're all different chronotypes. We all have a slightly different role in the community. And so, like, someone had to be in the slightly later shape. Later, later shift. Someone had to be on the earlier shift. And. But also, I think that those of us who feel like we are night owls, I am one of these people.

[Naehymareza]

I am too. I'm like, at 11:00pm to 1:00am I love working.

[Dr. Ellen Vora]

I love what happened to those hours. It turns out, in my case, was I a night owl or was I exquisitely sensitive to the effects of light when I wear these? I'm not a night owl anymore.

[Naehymareza]

Oh, gosh.

[Dr. Ellen Vora]

Which is a great way that it got me through residency, because you have to an overnight shift, but you're in the fluorescent lights and LED lights of a hospital, which for my brain, it's like, all systems go. I'm ready to go to the races. And so I think that some of us are more sensitive. And this is the design is our body has mechanisms for suppressing melatonin so that we can do the night shift mode so that we can but you're.

[Naehymareza]

Saying if I put on these glasses, I will now know if I am or am not a night owl. It's a night owl task you're giving your brain.

[Dr. Ellen Vora]

It's fighting chance of secreting melatonin in response to the dark and making you sleepy at like three hours after sunset.

[Naehymareza]

Also, back in the day, our ancestors didn't eat so much. They didn't live as long, but they also didn't eat this many meals all the time. I find three meals a day is a little absurd, I have to say. I don't. I mean, I'm like, I'm a breakfast skipper. I'm also a 2am to 10am sleeper, which is a different vibe. But do we have to eat so much?

[Dr. Ellen Vora]

I mean, many would say we should be eating less. I think that where we are right now is that we are eating so many refined carbohydrates, refined grains, added sugars, that we're on a blood sugar roller coaster. And that doesn't feel good. In every crash, we're a little ugh. We feel off. We feel sometimes, some of us anxious, some of us overwhelmed, some of us lose focus, we get sleepy. But also we then crave our next hit. So we're not eating in a very blood sugar stabilizing way. It also trains our body to not have a lot of metabolic flexibility. So it's the nature of our processed foods and even not just our ultra processed foods, but even just our very refined diet, like even pasta, bread, like these are technically processed. That has us really riding a rapid up and down and a more blood sugar stabilizing diet of fatty cuts of meats and berries and starchy tubers and full fat things. Like we're more likely to have stable blood sugar, where we're then not dropped into basically drug withdrawal, where we're then craving our next hit.

[Naehymareza]

You have in your book a hack that you talk about, which is taking a spoonful of almond butter every kind of like six to eight hours to regulate your body.

[Dr. Ellen Vora]

Yeah, There were so many years when I was like, okay, patient, let's overhaul your diet and have you eat in a blood sugar stabilizing way to treat your anxiety. And they were like, Dr. Vora, like, you're nice, but no, I'm not gonna pack a bento box of organic strawberries and bring that to work. And so I really started to meet people where they're at always. And you want to keep your blood sugar stable, but without a lot of effort. Something like almond butter, some people use coconut oil. Or ghee, clarified butter. Things that are basically pure fat or fat and a little bit of protein are slow to be digested, slow to be released into the bloodstream and create a safety net of stable blood sugar. So I'd have patients who would have their panic attacks on their subway ride home in the evening. That, like, that was their high risk time for panicking. They'd have a jar of almond butter at their desk, take a spoonful. Before they left the office, panic attacks stopped wholesale.

[Naehymareza]

Are you on the take for, like, Justin's almond butter?

[Dr. Ellen Vora]

No, I probably should have been.

[Naehymareza]

I do this thing, which you are maybe gonna think is weird, which is I do a tablespoon of olive oil in the morning because I think it's, like, good for joints. Sure. And then I do it in the afternoon. I do the almond butter thing, which I learned from you.

[Dr. Ellen Vora]

Yeah.

[Naehymareza]

And then in the evening, I do.

[Dr. Ellen Vora]

Honey, this is, like, absolute. Like, this is your secret to your success. Really? Yeah.

[Naehymareza]

You think this is okay?

[Dr. Ellen Vora]

I think it's good.

[Naehymareza]

I mean, I think almond, but all the time.

[Dr. Ellen Vora]

Here's the thing, is that we don't know what the research says. We don't know. We don't care what Dr. Fora says. If this is working for you, and it's certainly not harmful, our body will tell us whether this is working or not. And our job is to listen to that.

[Naehymareza]

I feel like I had an A and now I have an A on a curve. But that's okay. We do have so many studies for everything nowadays. And I want you to help people understand, like, what is a good study? What is a bad study? How do I know what a study is? Like, everyone's talking about creatine right now and creatine in women's bodies. Like, how should we be digesting medical research, especially when so much research is actually funded?

[Dr. Ellen Vora]

Yeah, okay. I have, like, a PhD thesis on this question.

[Naehymareza]

Okay.

[Dr. Ellen Vora]

I'll say it as quickly as I can, but basically, I think that the spirit of studies is a beautiful thing. Like, we used to just argue by assertion and be like, I'm your doctor and you should put a leech on your body. Because I said so.

[Naehymareza]

Because I think so.

[Dr. Ellen Vora]

So and then we're like, well, let's put it to the test. Let's see, like, what's the evidence? And there's beauty to that. We want to know the truth. We don't just want to work through our biases. And then that system got bought. You know, there are industry interests that now systematically influence that system. So what gets studied in the first place, what gets published, what gets, like if it was a negative finding, what never ends up in the journals in the first place. And then all the way down to what kind of financial relationships do the experts on the panels, all of that has industry interests influencing. So there's a place for it and it's useful and it's not perfect. And we did lose touch with two kind of anti evidence things. One is anecdotal experience. We really poo poo that we say like that's just anecdotal, like it like ends the argument. But anecdote is actually the base of the pyramid where at the very top, like a meta analysis of several randomized clinical control trials, that's what we consider our gold standard. But the only reason we ever have a hypothesis in the first place is based on anecdote at the bottom of that pyramid. And what I find is that one, we are getting even dustier at those wires of communication, of listening to our bodies when we only outsource our knowledge to what has been studied. Like, should I take creatine or not? Like the study told me I should study. Like we look back at that 10 years from now, maybe it's not reproducible anymore, right? How do you feel when you take it? Like is your body saying yes or no? I think we want to get better at that. And I also find that there's a man woman thing here because what gets studied and how we're measuring dosages and whether there's parity in medical trials, it's always biased towards, we're giving better information for a male body than for a female body. And we're being more dismissive of a female subjective anecdotal, like hey, I think this is happening in my body. And you know, for years we said a woman would go on the pill and she'd be like, I think I'm crying every day. And we'd be like, there's no evidence for that. So we just sent her home.

[Naehymareza]

Even though there was a plethora of anecdote for that, there was so much.

[Dr. Ellen Vora]

Anecdote, but it was hysterical. Women, women's anecdotes. And so then now we know indeed exogenous hormones influence mood. Because of course, like if you've ever had pms, you know that hormones influence mood.

[Naehymareza]

I mean this is, I think, one of the craziest things because women are responsible for the vast majority of medical spend. They are the drivers of medical decision making and families and their own health, convincing their Partners often to go get their parents, et cetera.

[Dr. Ellen Vora]

Living longer.

[Naehymareza]

Yeah, exactly. And yet the medical community has done a pretty shit job of studying women. I had Tamsen Fadal on here, who I know you know as well, and we talked about this study of menopause where they had linked the hormones, in that case, hormone replacement therapy to cancer, breast cancer. Once that story was out, even though there were countless studies saying that, hey, that earlier study was wrong. It's like, you can't put the cat back in bat when it comes to this. And now we're in this moment where, okay, for menopause, women are being prescribed HRT again. And noom, which is my brand sponsor for this podcast, like, actually prescribes it. Yes, this is where the studies really shake me. But also the opposite reaction. The reaction that everything is false. The liar's dividend. While one thing is true, if one thing is untrue, then everything can be untrue is also really scary because. Because there has been that shift now where, okay, in say, Europe, where there aren't the same capitalistic interests, there's a lot more regulation, there isn't the same industry funding of academic trials. They are saying similar science on certain things, including, say, vaccinate your child for measles, mumps to rubella. This has been around for hundreds of years, and now we're seeing distrust in that. So how do you reconcile that? As someone who's in the medical community and who understands, I think you in some ways skew a little. Woo, woo.

[Dr. Ellen Vora]

Yep.

[Naehymareza]

Yeah, right? Like a lot. Yeah. You like the honey?

[Dr. Ellen Vora]

I love it.

[Naehymareza]

Raw milk. You have questions around birth control for everybody. Not around contraceptive, but around birth control for everybody.

[Dr. Ellen Vora]

Right.

[Naehymareza]

But you also, I don't think, are part of the kind of like, don't vaccinate your baby.

[Dr. Ellen Vora]

So, so here's. And I think that one just, like, sidebar around the menopause and birth control anecdotal issues is that, like, we have societally a tolerance for female suffering and pain. That I think is different for men. And there's like this. They're intersecting layers of. When you add to that, if this is a black woman, we just have so much more tolerance for their pain. We allow it. And this is why we see maternal mortality and so much higher in black women. And so it's like there's ways that we don't take women's suffering and pain and complaints seriously. And so. And this is all kind of part of why I don't put all of my eggs in the basket of evidence is that it's just not a perfect system and we still need to listen to the subjective experience. And instead of saying there's no evidence for that, we say, maybe, but how.

[Naehymareza]

Do you not throw out the baby with bath water?

[Dr. Ellen Vora]

This is where we need to go back to, like teaching our kids to self regulate. Right. Because it's all about right now. We don't tolerate nuance in gray areas. So we're like, like it's this or that.

[Naehymareza]

Yeah.

[Dr. Ellen Vora]

Like you're in this cap or you're in that.

[Naehymareza]

You're Maha or not, you're Maha.

[Dr. Ellen Vora]

Never. The two shall meet. Right. And I think what's dangerous is that, you know, with the pandemic response, the systems of public health lost credibility by simplifying the message. I'm not saying I envy that job. I wouldn't want to have to think about, like, what's the right way to message this for our population? We're figuring things out moment to moment. We're trying to save lives. And like, I don't envy that. But I think that sometimes we underestimate, sometimes we overestimate, sometimes we underestimate humans. And I think we, there was some balance that we, we missed in terms of, here's what we think is the right choice for each of us to make. Sometimes it's for our own well being, sometimes it's for the collective, which we don't really have that mindset as an American culture either. It's like, what's for the collective? But sometimes it's, there are risks. And I think in acknowledging that we maintain credibility and by completely denying it, you lose credibility. And then someone turns and says, well, the whole system is untrustworthy, and then we're really in trouble. So we need to keep the credibility each step of the way. And sometimes it's admitting we're not totally sure we think this is the right choice. This has benefits and risks. We think the benefits outweigh the risks, but we're not invalidating the risks. And you're experiences.

[Naehymareza]

And I think that I have interviewed Dr. Fauci on this topic and I think he himself has said, yeah, like it would have been. I asked him, why didn't you say, I don't know more, why didn't we say that at the time? And it's like, yeah, I wish I could have said that. There were certain politics that made that very hard to say. And clarity is the job in some ways of public health officials, because they're giving this kind of like brute force message. To the world and. But there wasn't listening, there wasn't listening about like, okay, let's at least be able to have a conversation about lockdowns. Let's talk about the fact that women are seeing these weird changes in their cycle, you know, with respect to vaccine in certain cases and acknowledge that this might be happening. Let's talk about different age populations and how they may or may not benefit from the vaccine. X number of months out. I think the pandemic was such a moment of reckoning. And we did not just our public health officials, we as a society, the media, everybody, our politicians of the time, you know, just, we're not good at handling that nuance.

[Dr. Ellen Vora]

That's right. It comes back to the nine year old and the color wheel. Like, I do think that it's in our interest as a society to help all of us learn how can we hold two conflicting truths? How can we be with our ambivalence, how can we be in the messy, nuanced gray area of a situation? We're very black and white, we're very hyperpolarized. We're at each other, we're like, like, you're on that team, I'm on this team. And we won't even have a conversation. And I think that this is like at the root of so many of these problems. So if we find our calm in that moment, we have more idea labs then we can say, hey, smart person who I respect, who has a different opinion than I do, like, let me help me understand your perspective. And I think I would love a world in which the public health messaging says, we don't think you're idiots, let's talk about the real risks and benefits because it's complicated. And I think that's just it. Like all of my weird woo woo views. To me, I'm at every step of the way thinking through the relative risks and benefits. Because every choice we have, like Tylenol to raw milk, it all has risks and benefits. And we get to decide, I think we get informed consent is really critical. And then I think we have a right to decide for ourselves. There's a collective angle here too. But like, given my situation, here's the right balance of risks and benefits for me. And, and I think we get too much into like, this is all good or this is all dangerous.

[Naehymareza]

Right? But the communal stuff matters. Which is to say if you decide not to vaccinate your child against something that is hundreds of years of history and you're putting your child, like if you decide to Stagger your vaccines in a way that they do it in, say, Denmark. That's a very different conversation. Right. You know, so I think they're, there's a kind of nuance there. Yeah. Okay, last question. Before I ask you my final or my second to last question. Are you worried about therapists being replaced by AI because everybody's using ChatGPT?

[Dr. Ellen Vora]

Are you excited for it? I mean, I think it's confusing what happens when none of us has jobs anymore. It's confusing to me why it's not like the Jetsons where Rosie was doing our dishes and our laundry, but we got to be artists. Why is it that it's making our art and we're still doing our dishes? But I think that, like, it's, I want, I want the alleviation of suffering. Like, that's my goal is viscerally I'm uncomfortable with humans suffering unnecessarily. And I have patients who are like, you know, what's working for me right now is I get into my car, I drive home from work, and I have a conversation with ChatGPT and it's my new therapist. Hallelujah. Like, whatever is gonna get you up that path.

[Naehymareza]

What do you think ChatGPT can do better than you as a therapist? And what can it do less well than you?

[Dr. Ellen Vora]

So it can do almost everything better. Um, I think it's smarter. I think it's more insightful. I think it's has less discomfort with difficult confrontations. And currently, and this might change, what it can do worse is checking in on people is follow up. Because, like, it's, it's still directed by when someone's checking in with you. So someone could go into their CHAT GPT and be like, I'm having really low thoughts right now. Like, I'm in trouble. And then chat is a very good therapist in that moment. And then later they can be like, what's the square root of 26? And chat could be like, I'll tell you the answer. Be like, are you okay, bro? And so, but it can't, it can't just say, like, spontaneously when not prompted. Like, I'm still worried about you from that conversation we had yesterday. Are you okay? And chat currently can't do that, but once again, you're out of business. It'll be out of business. It'll be much better.

[Naehymareza]

You're out of business. Okay.

[Dr. Ellen Vora]

And that's okay because then I think what I'm actually really here to do at this point is, well, I, I, I'm even more of a writer right now than I am a therapist. Like, I still see patients.

[Naehymareza]

I always work on your second book.

[Dr. Ellen Vora]

But I, I want to. To spread ideas with the world. But I think that there's energy work that I am doing with patients that I still think actually we, we might be a ways off from. From AI to be good at energy work.

[Naehymareza]

Okay. There's also energy work sounds very woo.

[Dr. Ellen Vora]

Woo open a big can of woo woo worms that we're not even gonna open.

[Naehymareza]

Okay. I'm like, what a fucking cliffhanger. A second, second episode with you. Okay, then also the thing it can't do is it cannot like, like put its hand on your hand. It cannot like give you a hug. That's the thing that chatgpt. We'll see what Jony I've and Sam have in store for us, but right now that's not coming.

[Dr. Ellen Vora]

That's clearly coming.

[Naehymareza]

But you can't do that either, right? This is my last dumb question. Are you allowed to hug your patient?

[Dr. Ellen Vora]

Allowed. Not like there's so much boundary consideration. I am like 10 plus years in with so many of my patients. So we have figured out what are the right boundaries and sometimes like, and that's actually where a hug is all the more of a potent healing offering. As if we have a very distanced, very boundary relationship and then someone's going through like a huge grief. That hug in that moment I think is like a very profound intervention. And so it's kind of saying like, this is different and like, let's, let's acknowledge that and bear witness to that and like the human condition.

[Naehymareza]

There's also the privacy aspect in my perspective, which is like, I'm more likely to trust one human than I am to trust one enterprise that has created an app that is connected to all my other phones that location trackers can like identify through third party systems and trackers. So there's those things. And so that should give you a little bit of pause.

[Dr. Ellen Vora]

Professional ethics still count for something, but like you, you take an oath and there are boundaries to your profession and there's like conduct to it.

[Naehymareza]

And even if you're.

[Dr. Ellen Vora]

We don't have that with tech right now.

[Naehymareza]

Yeah, we don't. Last question. I ask every guest. What is something that you have a dumb question about? What's something that you've kind of pondered and not been able to figure out or ask ChatGPT yet?

[Dr. Ellen Vora]

I mean, my husband puts out, I'm dumb about everything other than the one thing I know. Deep, deep, deep. So it's like I'm all about functional mental health and then anything else, I'm useless. But I think that like one question that's always been on my mind and no one's ever been able to answer is like, so say you're trying to get from here to your destination and it's raining pretty significantly. If you walk or run, like which one ends up getting you more wet? Because it feels like if you run you're less time in the rain. But there's this way that you're like running into the rain and you feel this dramatically like getting wetter. And so I'd love to know the answer to like, what is the right strategy if you don't have an umbrella, it's raining, you need to get there. How are you going to minimize getting soaked?

[Naehymareza]

I love it. What do you do you have a hypothesis, a gut? What is your gut telling you?

[Dr. Ellen Vora]

We all instinctively run, but I kind of love when we all instinctively do something and it turns out that was wrong. So I'd love to like realize like it turns out if you just like we all, if we're cold, we go like this, right? And there's reason for that. But in certain ways it makes us experience the cold worse because we get shoulders there discomfort and non acceptance. So it's like I try to rel my body in the cold now and. And I'd be curious to know if I'm supposed to just like walk slowly in the rain.

[Naehymareza]

Yeah. Okay. I love it. I will find out for you. Thank you so much, Ellen, for doing this for it.

[Dr. Ellen Vora]

It's been a delight.

[Naehymareza]

So fun. That was a long conversation. But I just want to talk about three things that stuck with me. One was that quote from her book which said that your gut feel and your brain are talking to each other even if you're a gastroenterologist and your psychiatrist are not. I thought that was really well said and kind of goes to how we work as a body. I just learned so much from Ellen on that topic. The second was her point about why we're seeing more mental health issues in the United States and elsewhere. And I thought she really touched on something important, which is how can we be a country that's so wealthy, so innovative, so ahead of the curve, and yet in many ways so undernourished, so alone, so kind of divorced from the collective and our community and what does that do to our health as a society? And that relates to the third point, which is how we got to this point of real divide and real divide around science and health, you know, and the role that the pandemic played in that. I think that there's a real opportunity for more open conversations where we hear questions and talk about, as Ellen said, the collective, you know, we acknowledge and have these conversations in a public space and we talk about what's best for our health as individuals and as a collective society to move forward. So I don't know lots to think about there and I would love to hear what you think. Please send me a note. I'm aimaraza101mail.com or you can leave a comment or review wherever you're seeing this on YouTube, on Spotify, on Apple, wherever you get your pods. That's it for this week on Smart Girl Dumb Questions. This episode was produced with Dana Balut, Noah Friedman and Heli Cruz. Our theme music is by David Kahn and I'm your host Naima Raza. I'll see you next week and in the meantime, I'm going to go get a scoop of almond butter or honey or something. Bye.