I am delighted to have Michelle Shapiro joining me on the show today. She is a Native New Yorker and an integrative and functional registered dietitian who has worked with thousands of clients, holistically reducing anxiety, healing longstanding gut health issues, and lovingly approaching weight problems.
In our conversation today, we explore shame and eating behaviors, looking at self-empathy and the inner dialogue that usually accompanies weight-loss resistance. We examine whether or not obesity is a disease and the effects of adverse childhood experiences and dive into fasting, hormesis, autoimmunity, and the concept of surrender. We also clarify what intuitive eating involves, the role of highly sensitive bodies, and some common causes of digestive distress and bloating.
Michelle brings a wealth of knowledge to today’s insightful and engaging discussion. I know you will love it!
IN THIS EPISODE YOU WILL LEARN:
Why kindness and sensitivity matter when it comes to discussing the sensitive topic of weight
Why clinicians should view obesity as a symptom of underlying metabolic issues rather than a disease
How internal dialogue and protection mechanisms influence people’s food choices
How adverse childhood events and high-pressure social environments can increase the risk of eating disorders
How food allergies and fear can lead to disordered relationships with food
Why safety is the key to hormone regulation
Is intermittent fasting a dangerous practice?
The benefits of practices like grounding, Reiki, and acupuncture for overcoming anxiety and feeling safe in the body
The importance of self-reliance in healing, and the role of practitioners in guiding their clients toward self-awareness
What you need to focus on when implementing intuitive eating
The unique challenges that highly sensitive people are likely to face
“Adverse childhood events and high-pressure environments can certainly lead to eating disorders or disordered eating.”
-Michelle Shapiro
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Connect with Michelle Shapiro
Transcript:
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today, I had the honor of connecting with Michelle Shapiro. She is an integrative and functional registered dietitian. She is a native New Yorker who's worked with thousands of clients to holistically reduce anxiety, heal longstanding gut issues, and approach weight in a loving way.
[00:00:45] Today, we spoke about the role of shame and food behaviors, the concept of self-empathy, and the internal dialogue that goes along with weight loss resistance, whether obesity is a disease, the impact of adverse childhood events, fasting, eating and hormesis, safety and autoimmunity, the concept of surrender, what intuitive eating is and is not, common reasons for digestive distress and bloating, and the role of the highly sensitive body. I know you will love this conversation as much as I did recording it.
[00:01:21] Welcome, Michelle. I've been so looking forward to this conversation. Thank you for carving time out of your busy schedule to connect.
Michelle Shapiro: [00:01:28] It is the honor and joy of my week, my month, and it is certainly my honor and joy. Thank you so much for having me.
Cynthia Thurlow: [00:01:34] Absolutely. Well, for anyone that knows you already, they know that you stand on a pretty strong platform talking about healthy mindset around weight loss resistance. So, let's start the conversation there today, because there's so much at play beyond “sorry gym bro” science guys. It is not just about calories in, calories out.
Michelle Shapiro: [00:01:59] Absolutely. So, I have a personal weight loss story also, where I lost 100 pounds about 15 years ago. And since then, I've watched the nutrition world evolve so much around weight loss being this kind of morally bad thing or morally good thing, and watching this kind of nutrition in medical world really divide into people who say it's okay to want to lose weight and people who say it's not okay to want to lose weight. And through it all, Cynthia, my clients and your clients, they still have the same wish internally to want to lose weight, but now they're just afraid to express it because they think it's kind of the wrong thing to want.
Cynthia Thurlow: [00:02:36] Well, and it's interesting because I think in many ways, it's so complicated, so nuanced. And I say this as a middle-aged woman and until I had experienced some degree of weight loss resistance, I probably didn't appreciate the degree of frustration most women are going through. What do you think is driving a lot of the weight loss resistance that you see with your population? We probably have overlapping populations of women in particular. What is driving a lot of these concerns around weight? Is it a manifestation of images we see on social media and movies? Is it pressure that we feel from family and friends who may be well meaning, but maybe we don't internalize it that way? What is driving a lot of these concerns around weight?
Michelle Shapiro: [00:03:25] Yeah. So, there are people who are concerned about their weight for very rational medical concerns. Let's say if they're carrying 200 pounds over what their baseline is or just 200 pounds over what would be considered healthy. And I think that's also subjective, and I think something we can talk about too. And then there are people who are really just stressing about those kind of, "last 10 pounds." Those last ten pounds that are the difference between someone feeling really safe and really good inside of their body and not.
[00:03:53] I think that there's been messaging for 50 years around women's bodies being smaller, and the goal is always for women's bodies to be smaller. And we do confer some social benefits for living in smaller bodies, which is something that I find to be abysmal and I find to be grotesque, but it is true. So, I think when people are living in larger bodies, they are more likely to be discriminated against when it comes to even job acquisition and just in biases that people experience. So, there's real societal reasons why people would want to lose weight, and then there's real medical reasons why people want to lose weight.
[00:04:28] And I think that with what I've been seeing recently and with the advent of social media is that there is, again now this urgency either to lose weight, to look like the fitness influencer, or whatever that is, which used to be magazines, or there's this urgency to derail and stop all weight loss efforts, because then you're not body positive and you're not feeling, you know, like you're morally good again.
[00:04:49] So, I think we're very heavily influenced by social media, and I'm going to call our people out, Cynthia, our functional practitioners, because I think a lot of functional medicine docs also do get it wrong. And I would say functional nutritionists too, when they're focusing so much on the numbers and on weight that we start moving away from the root cause and moving away from those real reasons why people are weight loss resistant.
Cynthia Thurlow: [00:05:11] You bring up so many good points, and I think that it's important for people to understand that the way that I think about weight loss resistance now is very different than when I was first practicing as a nurse practitioner. And Ben Azadi says it best, "We get healthy to lose weight." And that really typifies versus you know don't make it the focus, understanding that there's some degree of nuance. It could be maybe you don't manage your stress combined with an inflammatory diet, combined with not sleeping well, combined with your transitioning from your peak fertile years to perimenopause, which is a gigantic shit show that we both know of. And so, I think that the degree of nuance and conversations around this are very important.
[00:05:55] I think, as a clinician, I know that discussing patient’s weight in many instances, makes people uncomfortable. It makes the clinician uncomfortable. It makes the patient uncomfortable. And yet there needs to be conversations around this in a safe space. I actually said many times, "You can say just about anything to a patient or client if it's said in a sensitive, compassionate, kind way," like, kindness wins. And then I would have colleagues that would walk into a patient's room and like drop a bomb and, like, walk away. And I'd say to myself, "If you had handled that totally differently, the information would have been received. The concern that you have for them would have been well received. But instead, now you've left this patient feeling ashamed and really uncomfortable, and they're less likely to seek out support in the future." How is shame interwoven with weight?
Michelle Shapiro: [00:06:47] Oh, wow. That's the question of the hour. It's interwoven in about every way, it's interwoven on a cellular matter. It's interwoven in the decisions and food behaviors we have. Shame will not produce positive health results in any situation. And because, again, we've had this really specific feedback from society that being in a larger body is bad. It is going to be the inherent value system of society that gaining weight is bad and makes you bad internally. I think when we can separate the science of eating from the morality of eating, we can get really positive health results.
[00:07:26] And I just have to also talk about the physician-patient relationship when it comes to weight. And I think where things get really messy is when a physician proposes that weight is a root cause or even a disease. I really view weight as its own symptom set. I think weight is just one symptom that we experience whereby a lot of doctors will say, "You are larger because you are larger." So, it doesn't explain why that happened in the first place. And most physicians do not have any tools to help patients with weight loss. So, for someone to bring something up to you and say, "Hey, you need to do this without providing a tool for it is in and of itself shaming." Because you're just saying, "I'm just telling you this for the sake of telling you this, but I have no way of helping you with this." And I'm actually going to condescend you a little bit and say you really should get this under wraps when I myself don't even know how to help you with this. So, I think that's where the shame comes in, in that doctor relationship too.
[00:08:23] And when doctors or even dietitians, any type of practitioner start viewing weight as more of a disease than just a symptom that someone's experiencing, it's like taking someone's vital signs. These are signs and symptoms so that the body is letting us know what's going on under the hood. It doesn't tell you what's going on under the hood, it just tells you that something may be going on under the hood.
Cynthia Thurlow: [00:08:43] Oh, I love that perspective. And I think much like a woman's menstrual cycle is a sign of whether your body is receiving healthy inputs, whether it's external, internal, etc. And there's been a movement and as you were talking, I started creating more notes for myself about characterizing obesity as a disease. And I know that there are some well-meaning practitioners that are doing so, so that we're getting insurance buy in a lot of these GLP-1 drugs, and this is not a con about those drugs. It is really just this paradigm shift that I'm starting to see within medicine that is objectifying obesity as a disease process, not as a symptom. Again, what are your thoughts around this? Because I think it seems like that's the direction things are going in right now.
Michelle Shapiro: [00:09:34] [sighs] Yeah, I literally had to sigh when you asked that question. Yes, I recently, since the Oprah documentary about this and that conversation she had, I've really noticed this shift in the conversation so much more because I've been posting about those in larger bodies. I don't even use the term obesity generally because I just really view it as a person who has one specific symptom of excess weight that they may be carrying on them.
[00:09:57] I think as you're gaining weight there are many inflammatory weight in excess or with lack of muscle. There are inflammatory things that happen as our adipose tissue and our muscle tissue is endocrine facing. So, it is going to create downstream effects. But the actual act of gaining weight doesn't necessarily mean and correlate with exact health outcomes.
[00:10:19] However, yes, as you're gaining weight, you can get a metabolic picture that starts happening. That metabolic picture we might talk about and say "You have metabolic syndrome." That might be something we would classify as a disease, but it is not something that is genetically brought on, happens immediately, and then there is this point of no return as we think of disease, where it's like, "Well, now you have a disease, and you need a medication to fix the disease." I think that's where we get confused.
[00:10:48] Now, is obesity literally classified as a disease? Yes, there's a diagnostic feature to it, but it's pretty symptom based. It's just based on kilograms over meters. It's your height and your weight. I don't believe that that tells you enough about metabolic syndrome or anything like that. And what's really missed is what is the actual disease, AKA what is the disease process like you're saying over time and what's happening as a result of you carrying that weight, because people at different weights have completely different metabolisms and different pictures, and you still have to find out what's going on under the hood. I also resent, and I use that word specifically. I resent the idea that's been perpetuated that obesity, now, as we call it a disease, has this very strongly genetic feature. It's like, what did we think was going to happen when we put the food system in the place it is, and we put all of these different environmental toxicants and pollutants into our bodies? Did we think that we’re going to magically start having genetic diseases? No, these are lifestyle-driven diseases.
Cynthia Thurlow: [00:11:52] Yeah, that's such a good point and it's interesting. I just interviewed, she's a New York-based endocrinologist, Dr. Rocio Salas-Whalen, and she was talking about how the terminology, when you're speaking about your patients is even starting to shift. You don't say this 50-year-old female who's obese, now you're saying this female patient who is BMI of X. But she was identifying that we need to start talking about our patients and not associating the patient with the disease process. And so, she was saying that for her, over the last several years, she's been making a concerted effort to be very conscientious about the terminology that she's using, so that patients don't get labeled, just like we say patients are noncompliant. For listeners, that just means we tell patients to do x, y or z, and for a variety of reasons, they may not do x, y, or z, and then they get labeled as noncompliant. And those kinds of labels can be harmful is what I'm trying to say. So really looking at patients as individuals as opposed to just labeling them and then stamping something on them and walking away.
Michelle Shapiro: [00:12:58] And as you know, if you have obesity in your medical chart, it lives there permanently. And to me, it's so silly because weight is a vacillating symptom. It's a vacillating part of our bodies, it changes. It's like having a fever and fever being in your medical chart forever, like weight changes all the time. So, for it to be that you are now obese person. Yes, I think there is A, moral implications of that. And B, physically, it seems silly and irrelevant to me because it doesn't tell anything really juicy or informative about that patient anyway.
Cynthia Thurlow: [00:13:29] Yeah, it's so true. It's like you go to a new doctor, and now there's all these electronic medical record systems sometimes that merge when you go to a new doctor, and it's like in 2012 you had a urinary tract infection. They're like, "Have you had any more symptoms?" And we're like, "No, that was 12 years ago." But you're right, it does follow you wherever you go. It just becomes part of your differential diagnoses or problem list, which for many of us, it's like you have a problem once it goes away, but then it follows you everywhere like a trained puppy.
[00:13:59] Now, when we're talking about weight and talking about shame and talking about things like self-empathy, how do you help your patients develop the skills to be able to view themselves with grace and compassion as they're navigating these conversations with you, their work with you, because I think that internal dialogue is incredibly impactful and powerful. And I always say, whatever the patient says to me, it's a hundred times worse what they're saying internally.
Michelle Shapiro: [00:14:30] Absolutely. Yeah. I think a lot of the work that I've done with clients really centers around that internal dialogue. You nailed it. Using a little bit of a within scope version of internal family systems, we'll get to know the different voices that we have around our weight and especially around food decisions. By the time someone is binge eating, they've probably had a conversation in their head between ten different voices for hours without realizing. So, a lot of it is focused around having people recenter within their bodies and understand what is their experience on a daily basis. How does it feel to be inside of our bodies?
[00:15:05] The amount of urgency that my clients feel to, whether from a chronic illness perspective or a weight loss perspective, leap out of their bodies like they do not want to be inside of their bodies is how uncomfortable it is. So how do we create safety within our bodies in the short term? And how do we then, when we feel safety, create that kind of dialogue and understand it better? And that's when you can change it is when you actually can accept and acknowledge that dialogue that happens. A lot of times we'll hear voices from mom. We'll hear voices from an old partner, an old boss, and those will be the dialogues and the voices that are actually making most of the decisions in their head instead of their real, authentic, honest voice.
[00:15:47] Our protection mechanisms often steer the ships, and when our protection mechanisms are in charge, we end up making decisions that we don't want to. And it can just be so exhausting, Cynthia, to be inside of your head and feeling really unsafe and threatened. I think of people who want to lose weight desperately as feeling very unsafe. So, a lot of it is just, how do we find that safety within our body? And it could be, again, through like some-- a little bit of just the somatic embodiment, like, how do you feel in your body? And then on the same level, like focusing on their identity. And what is your identity outside of your weight?
[00:16:20] For myself and clients who've experienced major weight loss, especially, people treat you completely differently in society, when you lose weight, it's like day and night. It's honestly frightening, because the same people that you've loved or known forever might even treat you differently in that way too and perceive you differently. So, it's how do we stay so stable and strong in our identity that we almost feel like a tree that's rooted in the ground and not like a tumbleweed blowing in the wind. And that's a lot of the work, is that safety, and that grounding, and really just understanding ourselves, I think, is the first place to start for many people.
Cynthia Thurlow: [00:16:52] I'm sure you do extensive histories with your patients and clients. What are some of the risk factors that put a woman-- we'll just say women right now put women at greater risk for developing unhealthy perspective around themselves. Is it the environment in which they grow up, is it the friends they choose to associate with? Is it-- I know that I had several girlfriends growing up who they were on the eating disorder spectrum. One was anorexic, one was bulimic. I know based on my background during my psych training was all in eating disordered behavior just by pure happenstance, and so, I always say those things have stayed with me because they made such an indelible impression. But when you're working with women, are there risk factors? What are some of the things that make us more susceptible to disordered relationships with food or poor body image issues?
Michelle Shapiro: [00:17:44] Absolutely. Yeah. I would say adverse childhood events would definitely be a risk factor. I would say if you have any concurrent mental diagnoses, like, let's call it anxiety or depression or OCD, those are going to leave people more open. I would also say, yes, socially, being in high expectation, high pressure environments, certainly can lend to eating disorders or disordered eating.
[00:18:09] I've really seen people who have different kinds of chronic illness too or people who felt different than other people in whatever way, if it was a disability or if it was any sort of invisible chronic illness even, we end up eating in a certain way to prevent illness. So, we end up becoming more and more afraid of certain foods that we think are going to make us sick, which is something that I'm seeing online a lot, which is these-- even again, our amazing functional people who we love so much, these functional medicine or nutrition practitioners who are really saying, "If you eat this, you're going to be sick." This creates this new fear set for people.
[00:18:47] And just anything that has taken a knock at your confidence or your identity growing up can make a huge impact too. And I think food allergies also can influence food behaviors again, because of that fear. And any sort of, again anxiety, any sort of behaviors that would influence your food behaviors or mindsets are going to influence the way you feel around food and your safety as well.
Cynthia Thurlow: [00:19:09] Yeah, it makes so much sense, and it's interesting. I was on a podcast last week in LA, and the conversation around orthorexia came up. And so, for listeners, this is people that develop a disordered relationship around something that's healthy, but to the point where they won't eat outside the house. If there's any concern that food's been contaminated with a seed oil or high fructose corn syrup, or they can't enjoy living their lives because they're so worried about exposure to potentially unhealthy things. And I've certainly seen a lot of spectrums of eating disorders. I would tack in orthorexia, like, that's an overt preoccupation with not just eating healthy, but fearing eating anything that isn't designated as sacrament, it's so important that it be pure and unadulterated and unprocessed. And I think that makes navigating our daily lives very challenging.
[00:20:07] And certainly under the context of this conversation around orthorexia, I was saying I see a lot of disordered relationships with food around intermittent fasting. And I know this is poking a big bear, but I think it goes with the saying, "The longer that I've been in this space talking about the value of this strategy, the more I see disordered relationships with not just fasting, but also orthorexia, overt eating disordered behaviors." And the message should never be not to nourish your body. That's never what the message is. But everyone has a different filter, everyone has a different lens. Sometimes people probably don't even realize that they are heading down a very narrow path for themselves. And you add in as an example, like most of my platform are women in perimenopause and menopause and maybe they've never had trouble with weight loss resistance, now they do. So, if a little bit of fasting is good, more is better. If being more restrictive with their carbohydrate intake is an example, over exercising, losing their menstrual cycles. So, I'm curious, as an objective outside person, what are your thoughts around these disordered relationships? Whether it's about when you eat what you eat, how do you make sense of all of that?
Michelle Shapiro: [00:21:25] Absolutely. I think the tool itself isn't the problem. It's the way that we interpret the tool. Are you using intermittent fasting as a way to gain control of your entire life and to feel better about everything and hanging on it, making you happy, and losing weight and doing all these things. If we make those decisions from a place of desperation or fear, the tool itself can become unhealthy. So, I don't believe that intermittent fasting as a tool is dangerous, unhealthy when applied to the right person at the right time. So, we have to ask ourselves, is this for me? Is this for someone else? Is this meant for me in the short term or the long term?
[00:22:06] So, if we can separate again that data from the actual tools that we're using and put the tools and the data together and separate it from the morality, that's where it becomes really important. But if something feels even a little too exciting, Cynthia, if it's like, "Intermittent fasting will do everything for me," I think that's where we might be in a place where we're like, "Why do we need something to do everything for us?" If it's just like, "You know what? I'm going to do intermittent fasting. Let me see how it works. Let's see if it works. Let me track the data and understand if it's happening, if the results are happening for me, that's a totally different story." You have to feel into yourself, is this coming from a place of love, acceptance, honest data research for self? Or is this coming from a place of desperation or fear?
[00:22:48] And I know people listening are probably saying, "But, Michelle, if I'm in a place of desperation or fear, wouldn't I want the tool more?" And the answer is "Yes, but that's when the tool can turn against you." So, if you are in that place of desperation or fear, I would have people look first at what do I need to do to bring my safety level up inside of my body and in my environment before I can start playing around, having fun with some of these different tools, but it has to come from the right place or it will become disordered and concerning, I think, but no tool is bad. And that's what I've been seeing a lot on social media, is people clumping the tools in together with orthorexia. So, intermittent fasting does not equal orthorexia. It doesn't mean if you're doing intermittent fasting that you have an eating disorder, the intention behind why you're doing something is what would make it disordered or not.
Cynthia Thurlow: [00:23:36] No, it's such an important distinction and one that I completely agree with. You've brought up the concept of safety multiple times in our conversation already, help listeners understand what that means, because at the root of safety is allowing your body to be in a state where it can receive, where your hormones are going to better. I hate to use the word balance, but where your hormones are going to be properly regulated. If your body is feeling safe, there's many down toward effects that come from that. So, let's talk around safety, because I do think this is a very important concept, not just about weight, but just about overall health and feeling good in our bodies.
Michelle Shapiro: [00:24:21] I would even say and agree with you, double that. All the root cause of autoimmunity in most cases is a lack of safety in the body. It's just our body when it doesn't feel like it can rest and like it has to defend or preserve, it acts in a completely different way than it would when a body does feel safe and at rest. If our body is constantly thinking about threats that it needs to defend upon or again, it could be a perceived threat or a realized threat, it is going to act in a weird way, hormonally, immune system wise. And our body has all these built in defense system to basically help keep us alive.
[00:24:57] And I know we all talk about cortisol all the time and the nervous system, there's all these like tricky words, but in reality, and these words that I think have been co-opted to be something that they're not. And in reality, your body has to feel like if it's doing something that your body has its own back and that you're going to be okay if you do something, basically. And that could be making a food change, that could be existing on a daily basis, so I think when it comes to our nervous systems and safety, our nervous systems only learn through example. So, if we have been consistently unsafe our whole lives, our nervous systems are going to act and send out hormonal signals and neurotransmitters and other signals throughout the body to behave in a certain way.
[00:25:41] If we can create safety and security within our bodies, then our nervous system can say, "Oh, my gosh, I can calm down now. I don't have to act in a certain way. I don't have to constantly activate that sympathetic nervous system." And that's where we can bring our body into really robust health. But you have to show your nervous system it's safe. You can't say, "Oh, I'm going to do ice on my neck like a vagus nerve thing." It has to be like, "We're in this together and rebuild that bond with your body and show your body we're going to be safe and okay."
Cynthia Thurlow: [00:26:10] Yeah. And it's interesting to me as someone who, until fairly recently, did not know that I had a high ACE score. So, I have a very high ACE score. I've shared this with the community, and it helps explain why I have had three autoimmune conditions throughout my lifetime, all of which are in remission, thankfully, because I'm doing the work. But when I was going through my training, trauma was really focusing in on big T Trauma. And I trained in Inner City Baltimore, so we saw it all, gunshot victims, murders, homicides, rape, etc., like, the worst of the worst, never realizing that little T trauma, emotional abuse, etc. The trauma of your parents’ divorce, getting teased. I think everyone gets teased as a child, but some of us are more sensitive to those kinds of stressors. And so, helping understand that that primes our autonomic nervous system to be leaning more in the sympathetic. So, fight, flight, flee, or fawn. And so existing under those circumstances as a child, I leaned into being the perfect child because if I was perfect, everyone left me alone. And you don't lose those things until you're actively working against them.
[00:27:23] And this is where for me personally, I'd love to hear what you think has been super helpful for your patient population. Things like Reiki, energy work, meditation, breath work, grounding, yoga, and not ashtanga, like doing yin or doing yoga slow flow, things that slow me down when I'm someone that tends to rev pretty high, although everyone is oftentimes surprised to hear that I'm a pretty intense person because I look very calm from the outside, but it just shows you that you're working very hard for your body to appear to be one thing when internally it is not.
[00:27:58] And I think there are many, many women listening, although we all have different circumstances growing up, I'm in no way saying, poor me, that's not the point of the conversation, but just understanding, you can go online and you can look for adverse childhood events scoring. And we've had many women reach out, they're like, "I had a one." I'm like, that's fantastic. I've had many other people that are five, seven, nine, ten, even higher. And so just from the perspective of work that you have found to beneficial for women who tend to be more sympathetic, dominant, what do you think are the low-lying fruit? What are the things that women can do fairly easily without having to buy a gadget? I'm not saying to go buy an Apollo Neuro, although I think I absolutely love the work that they do. But what are some of the low-lying fruit things that have been very influential in helping your patients navigate making their bodies feel safe?
Michelle Shapiro: [00:28:51] Oh, I love this question. And I will tell you a funny story that I have, one of my practitioner partners who I've worked on a lot of projects with is a naturopathic physician Dr. Robert Kachko and he was my doctor at first, and then I was like, "Oh, no, we're best friends and business partners. You think you're my doctor, we're done." And I went to his office for acupuncture for the first time. This was probably 10 years ago. And as he was putting the needles in, I was really nervous and I was shaking, and I was like, "Am I going to feel high from this? Am I going to feel loopy? What am I going to feel like?" And he looked at me and he said, "Would the worst thing in the world be for you to feel good?" And I was like, "Kind of, that would be really scary. I don't think I've ever felt good before. Yeah, that would be really scary."
[00:29:33] So, I think for a lot of people, it's much more about being okay with being happy and feeling okay, Cynthia. If you're not used to feeling okay, your nervous system is going to defend against that. So, when I'm working with clients oftentimes, after a month or two of working together, they might report to me, "My anxiety is so much better, but I'm like really tired. I'm really exhausted." And that scares them because they're like, where's the anxiety? First of all, where's that anxiety protecting me? And also, I hate feeling tired.
[00:30:00] And I'm like, basically, with a lot of these measures, what's going to happen you've been on a high of anxiety. Underneath that anxiety for years has been true blue exhaustion that you haven't felt. So, in this process, you might be feeling things that you haven't felt in a long time, and they might be good, some of them, or there might be the real feeling of exhaustion, but for most people of experience have these high ACE scores and minds through the roof, of course. But for many people like that, they haven't experienced safety and health and happiness inside of their body, and they're not even chasing it when they're trying to lose weight or do these other things. They're chasing the uncomfortable feelings that are comfortable for them because they're used to them.
[00:30:40] So, my goal with anyone is, if you're doing-- I love these tools that you mentioned, like grounding, reiki, acupuncture, I do them all the time with practitioners at home, is just to go really slow and titrate your way in and be so constantly just checking in with yourself. And I like to laugh at myself too where I'm like, "Really, Michelle, you were scared of feeling okay? I was scared. I really was. I was not used to it. And the reason we have these autoimmune diseases is to, again, defend and protect us. So, when we start feeling better and we start losing weight, our defenses come down. We're forcing ourselves to be more vulnerable.
[00:31:15] With weight loss specifically, you're going to have people looking at you potentially differently, who looked at you before. You might be having, I don't know, it could be any sort of interest. Even people who are like, "Oh, you're losing weight. I want to hear more about that." We open ourselves up to the world when we change things in our health and that's not often talked about, and I think the goal is if you're making yourself feel better, it's okay if you're scared of feeling better and don't realize it and go really slow and do things that start out by feeling familiar and then move your way outwards from that point. So, if it feels like really threatening and it feels really scary, maybe save that for later down the road. And if it's just like, going outside and putting your feet in the grass for five minutes and you're like, "Oh, this feels okay. And I feel okay, that it feels okay." That's a good starting point.
Cynthia Thurlow: [00:32:01] Yeah. And thank you for sharing a bit about your background, because I think for so many listeners, it's so validating to know that even people that are leaders in the health space have navigated a lot of these things. And you bring up a point about surrender. And for type A people who like to be in control, it is very, very hard to surrender to the process. And do you find for a lot of your clients, or even as you're navigating conversations, whether they're podcast hosts, the concept of surrender, I feel like that key theme comes up so often, and the people that struggle the most are oftentimes the one who need to give themselves grace to accept the assistance of well-qualified people that they're working with. I don't even want to say that it's a lack of trust, but it's trusting the process and also surrendering at the same time.
Michelle Shapiro: [00:33:00] I think it's probably the biggest theme of the work that we're doing, any of us in an office. And I always say when you meet with a practitioner who actually cares about you, which most practitioners do really care, that's why they do in the first place. Your nervous system's healing in the presence of that environment. So, a lot of the work that people are doing in coaching is really just to be seen. There's this line from Les Mis, to love another person is to see the face of God. And I always feel like just to sit across from someone who cares about you, you have mirror neurons firing off like that is healing in and of itself.
[00:33:35] Oftentimes when clients come to me, as a dietitian, I don't focus a lot of my work on the actual nutrition or food as you can tell, because there's a lot of work that has to be done before you start talking about food. And I'll notice in the beginning in their sessions, they will be harping on me, calories, fat, protein, carbs, micronutrients, like taking all the information they learn from podcasts. And most of the time, I'm just like, "I promise you we are going to talk about that, but it's going to be probably in two months, but I need you to know, I hear you and I know how important this is to you." And that's where the surrender comes in a little bit too that in these kind of practitioner relationships, they're not going to go the direction you think they're going to go, but you're going to get what you need if you're sitting across from someone who cares about you.
[00:34:17] Because that's really the basis of a practitioner relationship, is someone who cares about you and can witness you. And so that's where the surrender is, I think is like the ideas we have about how this is going to go. Michelle's going to put me on a 16:8 intermittent fast every day. I'm going to lose this, like, you have to surrender the expectations a lot. And really in a process with a practitioner, I always say to my clients, "I don't want you to trust me more than you trust you."
[00:34:41] So, in the beginning, they come to me and they're like, you're the expert. And I'm like, "I'm really not, in your body like you really are." So, once we listen to our own body signals, we naturally start to surrender. Because as we grow, we lose our connection to our bodies and what our body's trying to tell us and then we, eventually, hopefully come back to this baseline truth that "We know inside. That's the role of a practitioner is to pull up what we already know about ourselves." That's the surrender. I think that's most important is that the world is not going to save you. The white knight is you. You are the white knight in your own story, and you are going to save yourself. If you are determined to do it and you're willing to listen to yourself, surrender to the idea that the world is going to fix you, and that you are going to do it because I think everyone can.
Cynthia Thurlow: [00:35:29] Yeah, it's such a good point. And as you're having this conversation with me, I'm thinking about when someone has been disconnected with their bodies for a long period of time, how does that show up for them, somatically?
Michelle Shapiro: [00:35:43] Yeah, this is where I'm going to see hyper reliance on external cues for finding out what's going on with them. So, they are going to be sending me supplements. They're going to say, "Michelle, what do you think about this supplement? Michelle, what do you think about this food?" That's where I can tell that that connection to self is severed because their reliance is on the outside world. So, it's very clear. I've worked with thousands of clients at this point and many of my clients I've worked with for five plus years. So, it's like to know someone like that, I know the deal, and it's really interesting because if people are experiencing illness in one area, but then something pops up later and I'm still working with them, I can see that they're self-reliant in one way and not vulnerable anymore.
[00:36:24] Let's say weight. They lost the weight, whatever it was, but then they end up with like a [unintelligible 00:36:29] diagnosis later on. Then they start to question themselves in that same way too. And they have to start again learning to self-rely. The funny part of the work is that I'm often like, "Nah, let's not talk about the nutrition stuff." Not being dismissive, but being honest, like, "We have fish to fry and a bigger path to go down."
[00:36:46] So, I'll often see that with people being most vulnerable is when they start again outsourcing their power. And I think it's very natural to do that because at that moment where we're like, feel really helpless and that's when we actually need to turn to ourselves. But if you don't have the proof from your nervous system that you can help yourself, if you've been chronically ill for 50 years, why would you believe that you can help yourself in this situation also, so you have to keep proving yourself to yourself also.
Cynthia Thurlow: [00:37:15] Yeah. It's such an interesting discussion to have because I feel like most, if not all women, and this includes women on social media that interact with us, people in programs. And like, as an example, I'm running an intermittent fasting class right now. And the top five questions were all about supplements. Not about fasting, not about troubleshooting, but questions about supplements. And to your point, it's this higher level disconnect from self to say, "Well, what do you think about this, and what do you think about that? And why do you recommend this? And why do we recommend this over that?" So, it's just been an interesting, and I was literally looking at them before we jumped on this recommendation recording that that definitely reaffirms trends that I see with my own clients for sure.
[00:37:58] Now, there's this concept of intuitive eating that I know is not per se possible for everyone. So, if you are metabolically healthy, the concept of intuitive eating is probably one that comes fairly easily. I'm going to say. I'm making a broad generalization. Intuitive eating for a lot of people is not intuitive at all because of this disconnect from their bodies, they've got dysregulation of key appetite and satiety hormones. How do you navigate this concept within your practice? Or how do you determine when someone is ready to intuitively eat?
Michelle Shapiro: [00:38:31] Totally. Yeah, intuitive eating is more than what people I think it is. Intuitive eating is a set of 10 principles. It's a model for working with clients. You can work with a practitioner or use the principles yourself and go through the system, there's a book. I think the impression in society is that intuitive eating is something that's like, you just eat whatever you want and that's it. It's really this system for honoring your hunger cues, focusing more on your health and your vitality than focusing on a number on the scale. It's much more about not engaging with the food police in our heads, de-shaming food patterns and all that is actually quite beautiful.
[00:39:09] Like you're saying, the problem is that if we have any sort of physical illness or we have any sort of mental illness, it's really hard to navigate those signals because the signals are wonky. So, if we're constantly eating hyper palatable foods, they will inform what our hunger cues are. They will inform the messages that we're getting about what we should be eating. So, I have this amazing practitioner friend, Stephanie Mara Fox, who is a somatic eating practitioner, and she says somatic eating is the step before intuitive eating that everyone misses. And what that means is when I think about food behaviors, the most important thing is embodiment. So, before we start thinking about, what are we thinking about food? what are you feeling in your body while you're eating? And that's what I always bring people back to is like, "Well, if you're having a really big craving, where in your body do you see that craving? What color is it? Oh, you feel it in your brain and it's like light up hot pink. Like, I don't know if that means genuine hunger." So, it's the exploration also, if there is binge eating behaviors or emotional eating, how do we again explore that from a real somatic perspective? What's going on your body, not just your mind?
[00:40:13] Because our mind can play a little bit of tricks on us, as we know. So, like we said, with all of those risk factors for why we would make food decisions that we're not intending to make, those would have to be taken into account with intuitive eating. Also, it's very unfair, I think, for people with chronic illness to say that intuitive eating is for everyone, because if there are like real intolerances or food allergies that are not uncovered, it's unfair to say that you can prioritize eating intuitively over serious illness that people are experiencing. So, I think intuitive eating is a perfect tool for people who are very healthy and who do not have to prioritize other medical illness. And it's a great tool for people to incorporate with many other tools in their health journey. I think it's fantastic and I think it's brilliant, and I think it serves a smaller population than it's proposed that it serves.
Cynthia Thurlow: [00:41:01] Yeah. Because it's interesting to me how frequently I see on social media, and I'm very much a voyeur. Like, I'm an introvert. I love to take in information. I love to see how people critically think or not, for that matter. And I just have seen a lot of intuitive eating posts. I think there's thoughtfulness behind the post, but I agree with you that there's a lot. I'd like to think that way. I like to believe that there is good intention behind the post. But to your point, to my point, if you're not metabolically healthy, it's going to be very hard to intuitively eat. And you brought up the point the somatic form of eating is a missing link when most people are trying to navigate heading that direction, so that's certainly very important.
[00:41:45] One thing that I want to make sure that we touch on and this is a little bit of a pivot, the most common digestive concern that I hear from middle-aged women is bloat, which can be, as you and I know, it's like saying nausea. it's like saying dizziness, could be a million things. When we're talking about digestive distress, when we're talking about bloating, constipation, nausea, diarrhea, how does your lens work to demystify, determine what's driving this? I'm always thinking underlying food sensitivities. I'm thinking about people who eat in fight or flight mode because they're on the go. They're sitting in their car, they're yelling at their kids, they're stressed at work. What are some of the detective tools you use to identify these digestive symptoms that patients will share with you?
Michelle Shapiro: [00:42:32] Oh, absolutely, an amazing question. And I think what I'm the first thing that any functional practitioner does, we draw a timeline of all of our client’s health. So, I want to know from birth, before birth, if preferable, if we have any information until now, where has your digestion changed? Where have you noticed any peaks and valleys, any intersection points? That's where I'm going to find out a lot of really important information. I think a lot of practitioners rush to gut testing, and if you don't have the context behind what's going on in the body, in the environment, you're not going to get as much information as you could from that testing.
[00:43:09] And I feel the same about food intolerance testing too, where they often show what immune response is happening as opposed to showing what gut response is happening or why it's happening. So, I'm really doing that detective work on a talking basis, and we are going to explore symptoms, so much so that my clients start drawing the picture themselves. So, they'll say, "You know what, I didn't eat until 04:00 PM yesterday and then I started getting really weirdly bloated." And I'm like, "Well, let's talk about, are you noticing other symptoms? Are you noticing like you're burping? Are you noticing a weird taste in your mouth?" Now after seeing and witnessing these patterns, I have this beautiful pattern recognition hack that I can see with people where I'm like, "This could be related to this," and then we can draw those connections together.
[00:43:51] And I always implore my clients to in sessions draw those connections too, and say, "This may have happened starting at this time." I'm often seeing in people who have got issues, there's going to be in childhood some level of antibiotic use. I still am seeing a lot of people with leaky gut-like symptoms. And then I've seen a huge rise in acid reflux being the root cause of bloating, because most people don't think of reflux as being anything besides that burning. And I don't have any clients who have reflux with the actual burning, by the way. They have all these other symptoms. I have to be honest with you, with long COVID, I've seen a huge rise in reflux because of this relationship with histamines, it's whole bigger other day for us, Cynthia, which we've already talked about, [Cynthia laughs] but I think I've seen a huge bump in reflux.
[00:44:36] And I will tell you, when it comes to the somatic experience of being in your body, there is nothing more triggering for, I would really say, women than feeling bloated, because no matter what weight you are it creates this dysmorphic feeling around our bodies. So, it can be really triggering. So, what I'm doing with a lot of clients is also, when we're in the experience of bloating, how do we bring that nervous system into a more rest and digest state? Because then the cycle continues if we're activated. And it can be really, really triggering. I know bloating can be.
Cynthia Thurlow: [00:45:05] Yeah. And it's interesting how many women talk about bloat. And without question, it's like weight loss resistance and then bloating. Like, those are the two most common things that people will express beyond like insomnia, which in middle age, there's a lot of reasons why that happens, but I think it's so helpful to know that you see these same patterns with your own patients.
[00:45:28] And before we wrap up, because obviously, we'll have to bring you back for a second podcast, because there's so many different avenues we could have gone down. I know that you have been talking a great deal about sensitive individuals, and not sensitive as in your feelings get hurt sensitive, meaning that your body is more sensitive to environmental concerns, could be more sensitive to food. If someone's listening and suspects that they might be on that trajectory or they may be heading into that syndrome, what are some of the risk factors? And I know, again, high level because we could have a whole separate two-hour conversation just about this and for everyone to understand Michelle tends to work with very medically complex patients. So, POTS, dysautonomia, MCAS, long-haul COVID, but when you see people that are identifying themselves as being highly sensitive, again, not their feelings are sensitive, that they themselves are more sensitive to environmental, personal care products, food, etc. What are some of the most common things that will lend themselves to when-- Put them on your radar or more than likely suggest that they might be fitting into that paradigm?
Michelle Shapiro: [00:46:42] Yeah, there's been this phrase for a long time "HSP," highly sensitive person. The phrase we use is "HSB," a person living in a highly sensitive body. Again, you're more mentally sensitive or sensitivity is a very beautiful and intuitive thing as well. I've really seen a huge rise in those living in highly sensitive bodies since COVID to be honest with you. It's COVID-like syndromes, where people who normally would be fine, like being in the sun all day, now get really sick when they're in the sun, or they're in a supermarket and they feel really dizzy, or they feel like they have digestive issues after flying and almost feel like they have food poisoning sometimes, but they've never felt that way before.
[00:47:21] Even taking nutritional supplements, like a vitamin C supplement, could cause them to have these, what we call like flares almost. What I think has happened over time is that our nervous systems have been so dysregulated, our toxic burden has been so high, and we just all were so not in good shape for when COVID hit us. And we were so overstressed, we were so overburdened, we were under mineralized, undernourished from a micronutrient perspective. And I think that whatever work our livers were doing before just exploded after COVID. So, it's now estimated there's one table that they have developed where they're finding that almost 30% of the population in America has long COVID. Actually, that's how grand the numbers are.
[00:48:07] So, people that weren't in highly sensitive bodies are now in highly sensitive bodies, and we have to look at how our bodies operate in a different way now. So, we have to live in a way that accommodates them, but we still are pushing forward towards health. So, it doesn't mean if you're living in a highly sensitive body and your body's doing totally weird stuff, that it means it's going to be forever at all. It just means you have to play a different game. It's almost like you're playing chess against AI, you have to play on AI's level, essentially.
[00:48:33] Our bodies are, it's really in my opinion, like an evolutionary measure that our bodies have developed in a way that we have so many things to defend against, that our nervous systems and these huge viral attacks were just more than our bodies could handle. And now we have to tell our bodies they're safe again. It's the whole safety thing again, we have to say, "You know what? You don't have to mount that huge immune response on a vitamin C supplement, I'm fine, I got a vitamin IV. Myself, I was sick for like three weeks. It's okay. It's just a little vitamin B12." We don't have to react in this way, but there's a huge way to do that of course. And it's really about restrengthening the body in a lot of ways and also tamping down that immune response.
Cynthia Thurlow: [00:49:13] That's so interesting. Well, obviously I love this conversation. Please let listeners know how to connect with you, how to connect to your wonderful podcast, how to learn more about you and your work.
Michelle Shapiro: [00:49:22] Thank you. The joy was mine. You are obviously a fabulous interviewer and just humane, and I've loved connecting with you, and thank you so much. I'm also saying this here that you have to come on my podcast so that the world knows, okay. You can find me on my podcast, Quiet the Diet podcast, where we talk about all matters of-- We talk about safety all the time there too. We talk about functional medicine, functional nutrition with our amazing guests, and/or just solo episodes, either about weight loss, body positivity, living in a highly sensitive body, or all matters of functional medicine and nutrition.
[00:49:53] I have a private practice with four other practitioners and myself. You can work with us one-on-one in our coaching programs. And then I also have this information center called The Highly Sensitive Body Hub, where people can learn how do we navigate these bodies that don't make sense in conventional medicine? People are going to functional medicine doctors and getting sicker because of those interventions. It's like, where do you go when your body doesn't seem to work with the things that you're seeing online? So that's just an information center you can join anytime.
Cynthia Thurlow: [00:50:23] Amazing. Thank you so much, my friend.
Michelle Shapiro: [00:50:25] Thank you.
Cynthia Thurlow: [00:50:28] If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.
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