Blog.

Middle Sleep

by Ellen Vora, MD on Dec 2, 2020 / Share

We tend to stress when we wake up in the middle of the night– watching the clock and panicking about being tired the next day. But in many instances, waking up in the middle of the night is actually a normal physiologic occurrence called middle sleep. This is a break between two segments of sleep, our “first” and “second sleep.” It’s a time to pee, read, journal, reflect on our dreams, and have sex. The only critical thing is that we do all this by candlelight, in the dark, or wearing blue blocking glasses. Middle sleep is normal, but exposing the brain to artificial blue spectrum light in the middle of the night can confuse our circadian rhythm. So next time you wake up in the middle of the night, consider if this may be the break between two ~4-hour blocks of sleep. Rather than stressing, simply protect yourself from blue light (i.e., don’t look at the phone), and enjoy the hour without pressure to fall back asleep. Most of the time, you’ll get naturally sleepy after about 45-60 minutes.⁠

6 Steps to Better Immunity

by Ellen Vora, MD on Nov 23, 2020 / Share

Take a few steps to strengthen your immunity. Get your vitamin D from sunshine or supplement, get your vitamin C from fruits & veggies or a lemon squeeze in water, and get your zinc from meat, legumes, shellfish or supplementation. I love elderberry thyme syrup by Tru Botanica (not an ad, just a fan). And our immune system relies on darkness at night, sufficient quantity and quality of sleep, and a state of relaxation to function optimally. Just by leaving your phone outside the bedroom at night, you achieve more darkness, less doom scrolling and stress, and better sleep.

Gradually Reducing Caffeine Can Be an Act of Radical Self Love

by Ellen Vora, MD on Nov 20, 2020 / Share

I know I don’t make any friends with this one… but my goal is to offer helpful information.

Caffeine is an anxiogenic drug–i.e., it causes anxiety. Some of us are slow metabolizers, meaning it can have an even stronger impact. If you suspect caffeine impacts your anxiety (if you’re anxious and you consume caffeine, it probably does), I recommend gradually decreasing your caffeine consumption to see if your anxiety improves.

For anybody drinking coffee and taking meds for anxiety or insomnia, recognize that you’re taking an anxiogenic drug in the morning to wake up, and then another drug to treat the anxiety caused by the anxiogenic drug, and perhaps still another drug to treat the insomnia exacerbated by caffeine. Ideally you would avoid the drug that’s causing anxiety and insomnia in the first place.

I know caffeine is our favorite ritual and sometimes feels like our one true friend in the world. Just remember that caffeine feels so good because it’s the antidote to its own withdrawal.

Remember to make any and all changes GRADUALLY. Caffeine is a real drug with a real withdrawal.

Boundaries: Setting Relationships Up For Success

by Ellen Vora, MD on Nov 17, 2020 / Share

These days, we encounter a lot of aggressive boundary-setting (“you’re toxic, I’m ending this conversation, because boundaries”). I think we may have missed the spirit of boundaries. To me, boundaries are not just about recognizing our needs & protecting our energy. There’s a subtlety around intention– that the goal is to promote connection, not separation–but a connection that honors our needs.

Not: I’m setting this boundary because you’re a toxic bitch & I want you to know that & feel bad about it.

Or: I’m denying access to me as a punishment for your bad behavior, I hope you suffer.

Instead: I want our relationship to work, but the way we’re showing up for each other is not working for me & it’s damaging our relationship. I’m setting this boundary in an effort to protect our relationship & set us up for success.

Here you’re ROOTING for the relationship to work, for the other person to get it & successfully respect your needs.

Btw, when we’re mad at someone, we love it when their bad behavior goes from bad to worse. We love feeling even more justified in our anger & resentment. Argh, we think to ourselves, can you believe how awful some people are (and by comparison, how virtuous we are)? From this state, we unconsciously set unrealistic boundaries, designed to fail. Then we think: Ugg, I even set a boundary (how woke and amazing am I?) & she STILL did the thing. We’re done. I’m writing her off as a person.

Try instead: hey friend, I want our relationship to work. When you comment on my weight/use the incorrect pronoun/ask me if I’m having kids, I feel uncomfortable. I really want our relationships to work so I’m asking you to not comment on my body/use my correct pronoun/not bring up family planning, so our relationships can feel good for both of us. In this case, we’re rooting for them rather than trying to catch them in bad behavior. Our intention is for the other person to get it, to succeed, for us to be treated in the way we need to be treated, AND for the relationship to work. This is hard and humbling work, but it really comes down to whether we want more connection or more separation in our lives. Boundaries can achieve both.

Bipolar Might Be…

by Ellen Vora, MD on Nov 12, 2020 / Share

What’s the root cause of your bipolar? In my practice, I’ve noticed that the root cause of bipolar varies from person to person. For some it’s an undiagnosed or poorly-managed thyroid condition, for others it’s a reaction to eating gluten. I frequently see people with bipolar who are very sensitive to light. The same blue-spectrum light in the evening that might cause mild insomnia for one person might cause a manic episode in someone with this predisposition. Also, there is an underappreciated risk of SSRI medications, which is that they can induce what’s called “iatrogenic” (aka doctor-caused) bipolar disorder. And don’t overlook the role that substances, such as cocaine and alcohol, can play in inducing mania in vulnerable individuals.

Anxiety is the Tone of Modern Western Culture

by Ellen Vora, MD on Oct 27, 2020 / Share

If you could drop a litmus strip into the stew of modern western culture, it would reveal that the tone of modern life is anxiety. Anxiety is the verb, the vibe, the texture, the pH of our age. How did this come to pass?

I think our phones have played a significant and multifaceted role. Inequality, systemic racism, and the poison and trauma beneath the surface of our country also plays an immeasurable role.

And an underappreciated factor is that large corporations figured out that fear sells. We are being constantly marketed to with a message of: you’re not enough, you need fixing (with the product I’m selling you), and, by the way, be afraid.

Whether someone is selling you a new car, a diet program, insurance, or a high tech baby monitor, or they’re simply trying to convince you to tune in to news at 9, they’re all selling you on their product with the same platform: there’s something to be afraid/uncertain/doubtful of, and you need what I’m selling to keep you safe and okay. The rest are trying to sell you a product to soothe your nerves after being so afraid. Corporations trying to make money have turned us into a generation afraid.

A Reflection on “Personal Responsibility”

by Ellen Vora, MD on Oct 22, 2020 / Share

A few friends called me in to reflect on the wording I used in a recent social media post about personal responsibility in health. I now understand that the term “personal responsibility” can be a dog whistle denying the structural disparities, systemic racism, and economic inequality that impact our access to healthy food, education, and freedom from stress and trauma. Thank you for calling me in.

Here are some reflections on this issue: the structural disparities and systemic racism are undeniable and infinitely impactful. However, it’s a both/and. We need to be having both conversations. We need activism & policy change and there are inexpensive, accessible things we can do as individuals to feel better. Education on strategies for better health does not have to take away from prioritizing policy change, and by avoiding the conversation, we do a disservice to those who sorely need better physical and mental health today. Better sleep and a few minutes a day of breathwork can happen in tandem with activism (in fact, they can help us have the energy to fight to make the world more just).

This is about reclaiming the power away from the corporate interests that have told us how to eat, what to drink, and how much to scroll, and handing the power back to the individual.

Here are a few inexpensive tips to help you feel better today:

don’t keep the phone on the bedside table at night
get vitamin D from the sun
take 30 seconds to do a breathing exercise (inhale for 4, hold for 7, exhale for 8)
swap out processed foods for real food (try: rice & beans with frozen veggies)

Yes, we need to focus fiercely on policy change and anti-racism activism. And we also need to remember the small, free changes we can all make as individuals to reclaim our mental and physical wellbeing and take back our bodies from a world trying to make money off of us at the expense of our health.

Normalize Miscarriage

by Ellen Vora, MD on Oct 7, 2020 / Share

Originally published on Medium.

Image: Chrissy Teigen shares an intimate look at her immense sadness after losing her baby

When I was ten weeks pregnant, I took a deep breath and posted about it on Instagram. I knew there was a risk I might have to return, tail between my legs, to admit I had miscarried. But that was exactly the point. There’s an unspoken rule to keep pregnancy a secret until you’re in the “safe zone” of the second trimester (twelve weeks). Why? Because miscarriage is common in the first trimester, and we don’t want to have to talk about it. I believe this perpetuates an idea that miscarriage is shameful, that people can’t handle talking about it. Neither of these things are true, so I decided to use my social media platform to model a new kind of behavior, announcing my pregnancy in the first trimester, owning this uncertainty in a public forum.

That uncertainty in the first trimester is very real. As a physician, I’m aware that miscarriage occurs in about ten to twenty percent of pregnancies, and almost all of that risk falls in those first 12 weeks. Understandably, people wait until the risk of miscarriage is considerably lower before they tell the world.

But there’s a problem with this: we rarely hear about the early pregnancies that end in miscarriage. It creates a biased perception that all pregnancies you hear about magically work out. And then, when someone has a miscarriage, they’re left feeling isolated in that experience and suffering in silence. They wonder: what’s wrong with me? Why did this happen to me and not to everyone else? But in reality, it happens so often — we just don’t hear about it. Miscarriage is a last bastion of secrecy and shame. I felt called to put myself in this exposed position so that, in the event of a miscarriage, I could offer up my lived experience to help shift the conversation around miscarriage.

Then, at eleven and a half weeks, I miscarried.

Trust Yourself

by Ellen Vora, MD on Oct 1, 2020 / Share

Women: trust yourselves. Our medical system is subtly and systemically misogynistic (and racist, and fat-shaming, and the list goes on). If you are experiencing something with your health, and you’re met with a dismissive or invalidating attitude from healthcare practitioners, do not let this make you shrink into shame or silence. Trust your body. And anytime something smells like b.s., speak up, push back, advocate for yourself. Rather than questioning yourself, question the system.

When We Say “Yes” But We Really Mean “No”…

by Ellen Vora, MD on Sep 30, 2020 / Share

Marshall Rosenberg introduced me to the concept of a true “yes” and true “no” in Nonviolent Communication. If someone asks you to do something, and you can hear your body whisper “no”, but you hear your mouth say, “yes,” you are giving your false yes. We do this to avoid confrontation and to avoid disappointing people. Especially for women, we’re conditioned to say yes, people-please, and meet the needs of all of those around us without regard for our own personal truth. We might even be out of touch with our needs and energetic limits. Next time, try to muster up your true no. They may protest or be disappointed. Do it anyway. You don’t need to justify it (that’s just you doubting yourself). Begin the powerful practice of honoring your own truth. The surprise ending to this story is that it ends up being kinder to those around us than betraying ourselves to do whatever is asked of us.