Episode 213: Holiday Boundaries & Autoimmune Disease with Dr. Ellen Vora

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Setting Holiday Boundaries for Autoimmune Health

Boundaries are a hot topic, and there are a lot of definitions. On a map, a boundary is simply the line – the border – between two geographic areas. Interpersonal boundaries are the lines we draw within relationships in support of our wellbeing. There are also intrapersonal boundaries – those are the ones we set with ourselves and they’re just as important. We tend to notice boundaries most when they’re getting crossed – by other people, or by ourselves. We also notice when we struggle to set them at all. Today, we’re focusing on the holiday season. It can be a high pressure time, mentally, physically, spiritually, and emotionally. And if you have autoimmune disease, there’s a powerful intersection between your ability to set boundaries and your ability to protect your health during the holidays. So, we are here to help! In this podcast, we share tips for setting healthy boundaries around food, time, energy, and money. My guest is Dr. Ellen Vora. She is a psychiatrist who takes a functional medicine approach to mental health. I love the way she educates around boundaries, which is why I asked her to be my guest today. She is also the author of the book, Anatomy of Anxiety.

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Show Notes

  • Intro (0:00)
  • Thank You to Our Podcast Sponsor – The Chronicon Community (2:35)
    • Founded by Nitika Chopra, a woman with autoimmune disease herself, she wanted to create a place where people felt supported but also inspired. Chronic illness may shape our experience, but it’s not our identity. Chronicon is an invitation to hope.
    • This online community is filled with diverse members from around the world. Women, men, and non-binary people are all welcome. It’s a place where real friendships are born.
    • There are also live, virtual events every week, led by experts on a wide variety of topics to help you thrive, as well as workshops led by community members. Chronically Creative is an art initiative, and Chronically Beautiful is led by a beauty editor who has an autoimmune skin condition herself.
    • Join today! Your first week is free. If you love it, membership is available monthly or annually. And scholarships are available for people who need financial support. Nitika’s goal is to make this community accessible to everyone.
  • Meet Dr. Ellen Vora (4:07)
    • Dr. Ellen Vora is a psychiatrist who takes a functional medicine approach to mental health. She is also the author of the book, Anatomy of Anxiety.
    • Early in her career, she became disenchanted with her conventional medical school training. The medications she was taught to prescribe didn’t always leave patients feeling better. She didn’t feel like she was really helping people.
    • Simultaneously, she found herself in a personal health crisis. She was experiencing inflammation, depression, PCOS, constipation, skin rashes, and joint pain. And in spite of doing everything “right” according to what she was taught in med school, she kept getting sicker. It took alternative approaches to restore her own health, and that ended up changing her professional approach to psychiatry to one that was more holistic.
  • Learning to Set Boundaries by Listening to Our Bodies (6:43)
    • Setting boundaries is a sacred pause, where we ask ourselves, “What is my true yes, and my true no?” This is something we often have to learn as adults, because it’s not how most of us were raised. Instead, children are often trained to people please (especially girls). The art and science of boundaries is to recognize that conditioning, and start creating that sacred pause where we check in and learn to listen to the language of our body, which usually gives a clear signal of a yes vs. a no.
    • Martha Graham, the grandmother of modern dance, said there are two main movements of the body: expansion and contraction. Applying this to boundaries, our body expands when we want to do something – when it’s a true yes, but contracts when we don’t want to do it – when it’s a true no. Expansion often feels lighter, more open, less tense…it feels good! Contraction often feels tight and tense; it’s a form of shutting down. The more you tune into your own body, you’ll learn how your body expresses your true yes vs. no.
    • Setting boundaries is the practice of acting in alignment with our bodies’ direction, and respecting our own needs. It can be hard to do, and it’s not something we master instantly, but with practice, it is something we can learn to do. Each time we set a boundary that honors our own needs, we witness ourselves being true to ourselves, and that in itself is deeply therapeutic.
    • Taking this sacred pause and learning to listen to our bodies, helps is in other ways in addition to setting boundaries. We get to feel the mind-body connection at work. It gives us moments of calm within a stressful day. And it allows us to be guided by our inner voice instead of the loud voices of others. This simple pause is an act of self-care, self-knowledge, and self-respect.
  • What’s Missing from the Boundary Conversation on Social Media (15:02)
    • It’s wonderful the conversation is happening, and there have been some great books written recently: Set Boundaries, Find Peace by Nedra Glover Tawwab and The Book of Boundaries by Melissa Urban.
    • However, social media conversations don’t always contain nuance. It’s wonderful that people are recognizing that their needs are worthy of being met and speaking up to advocate for those needs. However, we have a lot of anxiety around these conversations because they feel confrontational, and we fear our boundaries won’t be respected. So, we may bypass a gentle approach and go straight to an angry approach that villainizes the other person.
    • On social media, people use labels like “narcissist” and “toxic person” regularly, and seem to celebrate cutting people out of their lives. While there are times when we may need to do that, hopefully that’s rare. It shouldn’t the be the first step in setting boundaries within a relationship.
    • Ellen’s approach to boundaries is influenced by Marshall Rosenberg, author of Nonviolent Communication. Her goal is to preserve and improve the relationship if possible. It’s not about putting up walls. It’s about creating safety for closeness. So, the language used is very different. Boundaries can be clearly and kindly expressed.
    • She had a patient who was struggling with infertility, and it was a painful topic. An older family member continually asked her about it, and the patient considered cutting this person out of her life. Instead, Ellen coached her to try a different approach first, where she said, “I love you, and I love our time together. And there’s one subject that when you bring it up, it makes it really hard for me to feel comfortable and safe around you. Can we agree to not talk about that, so that we can continue to enjoy each other’s company?” The family member agreed. She didn’t know it was a painful topic and had meant no harm, and she respected the boundary going forward. The relationship was preserved. A harsher boundary wasn’t necessary.
    • Eileen noted that in her experience, when she trusts herself to uphold a boundary, it’s easier for her to use a gentle approach. When she fears she won’t stand up for herself and will allow a boundary to be crossed, that’s when her approach is more likely to be harsh. The more experience we gain setting and maintaining boundaries, the more we learn to trust ourselves.
  • Thank You to Our Podcast Sponsor – Wahls Protocol Mobile Program on MasterHealth (23:32)
    • Dr. Terry Wahls is one of the most popular guests on this podcast, and many of you have been inspired by her story. Through diet and lifestyle changes, she dramatically improved her MS symptoms, going from a wheelchair to a bicycle. She then created the Wahls Protocol to help other autoimmune warriors reclaim their health too.
    • Here’s what Dr. Mark Hyman says: “For anyone suffering from autoimmune or other chronic health problems, The Wahls Protocol is life changing.”
    • That said, new diet and lifestyle programs can be hard to start and hard to maintain. This is where this mobile program shines. MasterHealth’s expertise is in developing personalized coaching apps to help people make lasting habit changes, and this one is designed for the Wahls Protocol specifically. They use behavioral science principles to help you create new desirable habits and extinguish the undesirable ones. Doesn’t that sound great? And they also help you maintain those healthy habits through stressful times.
    • In addition to the habit coaching, you also gain access to a supportive community of people focused on achieving the same goals as you.
    • Get started today and use the code PHOENIX15 to save 15% off the annual program.
  • Time and Energy Boundaries: Holiday Events (25:12)
    • Sometimes we want to attend, sometimes we don’t want to attend, and sometimes at the last minute, an autoimmune flare might change our mind about attending.
    • The first step is checking in with your body: do you feel a true yes or no about attending? If the answer is no, you’ll want to communicate that kindly to the host, thanking them for the invitation but explaining that you won’t be going.
    • It’s optional to share your reason. Sometimes that helps the host understand. For example, “I’m so grateful for the invitation, and I love spending time with you. This event isn’t right for me for this reason.”
    • Other times, you might practice saying no without an explanation. This can be especially helpful with a person who usually debates your reasons for saying no.
    • Most people will accept a no graciously. If someone does protest or argue, that’s not a reason to change your decision. You aren’t responsible for the feelings other people have about your boundaries.
    • The overarching principle is recognizing your worthiness of living your life in a way that honors your own needs.
  • Keeping a Boundaries Journal (30:46)
    • The practice of setting boundaries is a beautiful self-awareness exercise, and it can be helpful to process your experience with a journal. Each time you set a boundary, first give yourself credit and celebrate yourself for doing it! Then write about how that felt for you. Was it easy or was it difficult? What language did you use? Did you use a one-word no, or give a reason? How did people respond? Were they respectful of your decision? Did they admire it? Was there pushback? Did you change your decision based on their response? Do you want to do anything differently when setting a similar boundary in the future?
    • It can also be helpful to write about those times when you don’t set or maintain a boundary, allowing your “true no” to be crossed. Be kind to yourself in those moments. Noticing is the first step to changing that pattern in the future. How did it feel to say yes when you meant no?
  • Saying Yes When We Want to Say No (32:07)
    • It’s tempting to blame other people for crossing our boundaries, but ultimately, we are responsible for setting and maintaining them. We cannot control other people’s behavior, so boundaries are about our own behavior instead. How do we respond when someone tries to cross them? We might need to express the boundary more firmly if they didn’t respect a soft approach. We might choose to put a physical boundary in place that’s harder to cross. It depends on each situation.
    • There will be times we allow a boundary to be crossed, saying yes when we want to say no. In those moments, we can learn a lot about ourselves, but also about the consequences of that choice. For example, if you make a commitment you didn’t want to make, you might cancel at the last minute because you never wanted to do it. This leaves the other person in the lurch. A clear no in the beginning would have been kinder. If you do follow through on the commitment, you might end up feeling resentful. A resentful yes is not a gift to the other person. Sometimes we think that saying yes is the nice thing to do, when actually, being honest is much better for everyone involved.
    • Saying no clearly and respectfully within relationships builds trust. It gives the other person permission to do the same. And when we do say yes, we can trust each other that it is a yes, free from resentment. A boundary practice isn’t just about expressing our own boundaries. It’s also becoming comfortable with others expressing their boundaries to us.
  • Thank You to Our Podcast Sponsor – ShopAIP (37:17)
    • As we enter the holiday season, baking cookies is a tradition in many families, and you don’t have to give that up if you’re on the Paleo Autoimmune Protocol. ShopAIP sells a wide variety of cookie mixes, including two cut-out cookie mixes. And for those of you who don’t want to bake but do want some holiday treats, ShopAIP also sells 5 varieties of pre-made cookies from Jack’s Paleo Kitchen. The holiday season is filled with lots of food temptation, and it’s much easier to stick to your healing diet if you don’t feel deprived. ShopAIP can deliver deliciousness to your door.
    • ShopAIP is an online store dedicated to the Paleo Autoimmune Protocol. With hundreds of items for the elimination phase of the AIP, and products labeled by reintroduction category as well. You can find protein bars, sauces and condiments, AIP-friendly spices, cooking and baking ingredients, waffle and pancake mix, delicious snacks, and more.
    • If you’re a first-time customer, use the code PHOENIX for 10% off your order. Purchase here.
  • Food & Alcohol Boundaries: Holiday Parties (38:45)
    • If you get invited to a party where food is being served, and you think it won’t fit your dietary needs, it can be uncomfortable to express those needs. We need to begin from the place of knowing we aren’t wrong to have special dietary requirements that support our health, and we are worthy of getting those needs met.
    • Ellen has special dietary needs, and for a long time, she felt shamed and judged by others for her food choices. She also felt insecure about seeming weird or high-maintenance. So, it was very hard for her to decline the food offered, even when there were health consequences afterward. Eventually, after getting sick multiple times, she decided it wasn’t worth it. She stopped compromising her dietary needs to please someone else, and she started advocating for herself.
    • Ellen doesn’t expect the host to meet her dietary needs. She knows that can be difficult, especially with multiple guests. Instead, she explains her dietary needs and offers options. She might bring a dish that both she and others can enjoy. Or she can eat before the event and then carry a small snack in her purse, in case she needs it.
    • Ellen has also noticed that more people have special dietary needs now, and she’s no longer the only one bringing a special dish to a gathering. By advocating for her own needs, she makes it easier for others to do the same.
    • Similar to food boundaries, alcohol boundaries can feel even harder to set, since parties often center around alcohol. If you are choosing not to drink, the same foundation applies: you are worthy of making that choice and having it respected. Ellen often brings seltzer to a party. It’s a non-alcoholic option that both she and other attendees can enjoy. If you’re carrying a glass, people don’t usually question what it contains.
    • When people have strong reactions and objections to our dietary choices, there can be a lot of reasons behind those reactions. The important thing to remember is that it’s not about you – it’s about them. You don’t have to drink alcohol, or eat certain foods, to make other people comfortable.
    • The dietary boundaries we set are a radical form of self-love that supports our own wellbeing. If people challenge Ellen, she simply says: “This is how I take care of myself.” It’s clear, calm, and puts the emphasis on her own needs. It’s not about the other people.
    • If you do break your own boundaries under pressure from other people, it can be interesting to reflect on why you chose to do that. Not in a shameful way, but rather in a way that leads to more self-awareness. Sometimes, we want people to challenge our boundaries so we have an excuse for breaking them and can then blame other people. (Note: this is different from knowing our wiggle room on a healing diet and intentionally allowing some food freedom with consequences we know we can manage. Breaking a boundary is different. It’s all about intention and whether we are directed by inner wisdom vs. outer pressure.)
    • Other Helpful Podcasts: Ep. 127 – Social Lives and the AIP and Ep. 95 – Religious Traditions and the AIP.
  • Financial Boundaries: Holiday Gifts (48:17)
    • There’s a lot of spending pressure around the holidays, and many people go into debt to meet those expectations. Just like other boundaries, we can set spending boundaries around the holidays too.
    • In mutual gift giving situations, one option is to pick a dollar amount that suits your budget, and ask everyone if they’re willing to stay within that dollar amount. Explain that you’re trying to keep your financial health this holiday season. Often, the other people feel liberated. They have budgets too. This also expresses the value that you don’t show your love with a dollar sign.
    • There are more revolutionary approaches as well, like questioning the idea of gift giving altogether. Agree to do something else instead. Maybe write each other heartfelt notes. Maybe craft a group experience. This shifts the focus away from consumerism, and instead on expressing love and connection in other ways.
  • When We Break Our Own Boundaries (50:39)
    • Holiday boundaries can be challenging and we are imperfect people. We might find ourselves eating food that causes a flare, or overbooking our schedules and getting exhausted, or overdoing gifts and going into debt.
    • We can feel a lot of shame when this happens. Self-forgiveness is part of the process of learning to set boundaries. If you’ve experienced childhood trauma, shame might be something you were taught young, and it might be a feeling that is tapped quite easily, where mistakes make you feel like there’s something deeply wrong with you.
    • Childhood trauma also increases the risk of developing autoimmune disease, and there are many possible reasons. The stress alone is enough to dysregulate the immune system. But there’s also a possibility that deep shame triggers an autoimmune response. If that resonates with you, a path forward is radical self-love and self-acceptance and finding a safe way to process that shame, realizing that you didn’t do anything wrong as a child, and you are not fundamentally bad now.
    • The ability to set and maintain boundaries is based in a feeling of self-worth – that we are worthy of having our needs met. Healing shame is foundational to believing in that self-worth.
    • This isn’t something that happens overnight. It’s a process. One step in this direction is noticing when we break a boundary, making a conscious choice to do so, and instead of feeling shame, make a promise to our body that we’ll explore this further in the future. It’s like couple’s therapy with your body. Let your body know that while compromising the boundary wasn’t ideal, your body is still worthy of having its needs met. That internal conversation can be very healing.
  • The Anatomy of Anxiety (54:02)
    • Ellen’s book focuses on reducing anxiety in all areas of our lives, including anxiety surrounding boundaries.
    • It’s written through a functional medicine lens and divides anxiety into two types:
      • False (or avoidable) anxiety is our body tipped into a stress response from some state of physical imbalance. The first half of the book focuses on practical tips for restoring balance.
      • Purposeful anxiety isn’t due to a physical imbalance, but it’s also not necessarily a pathology. It’s our inner compass, nudging us to course correct when needed. The second half of the book helps people listen to this anxiety and the wisdom it may hold.
  • Outro (56:12)

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