You can also check out this episode on Spotify!
On this episode, Melissa Urban talks candidly with Dr. McBride about her struggle with drugs—and how her recovery stemmed from creating healthy boundaries around food, substances, and interpersonal relationships.
Her latest book, The Book of Boundaries, is about the importance of setting limits on relationships and choices, and putting ourselves back in the driver’s seat of our health and wellbeing.
Melissa is living proof that health is about laddering up from self-awareness to acceptance to agency of our body and mind.
Join Dr. McBride every Monday for a new episode of Beyond the Prescription. You can subscribe on Apple Podcasts, Spotify, or at lucymcbride.com/podcast or at https://lucymcbride.Substack.com/listen.
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Please be sure to like, rate, review — and enjoy — the show!
The full transcript of the show is here!
Dr. McBride: [00:00:00] Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is "Beyond the Prescription," the show where I talk with my guests, like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as more than the absence of disease. As a primary care doctor for over 20 years, I've realized that patients are much more than their cholesterol and their weight. Our stories live in our bodies. I'm here to help people tell their story and for you to imagine and potentially get healthier from the inside out. You can subscribe to my weekly newsletter at lucymcbride.com/newsletter and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts. So let's get into it and go beyond the prescription.
Today's guest has been on the New York Times' bestselling list six times. She is the creator of the Whole30, which is not just a diet plan. It's a way to rethink our relationship with food. Melissa Urban joins me today to talk about overcoming addiction and the lessons learned in recovery that inform how she thinks about food, nutrition, body image, and the boundaries we set in our everyday lives. Melissa's newest book is called "The Book of Boundaries," published in October 2022. In it, she describes how we can say yes to things we need and want and no to things we don't to put ourselves back on the driver's seat of our health. Boundaries, in my world and in hers, provide the groundwork for improved health and well-being. Melissa Urban, thank you so much for joining me today.
Melissa: [00:01:48] Thanks for having me. I'm excited to chat with you.
Dr. McBride: Here's why I wanted to have you on the show. The way you talk about boundaries and the importance of setting limits on our relationships, our choices, is so important to how we show up in the world, how we relate to food, how we relate to alcohol and other substances, how we relate to other people, and how we feel about our own bodies that it's really at the core of what, in my opinion, health is.
[00:02:17] Health, as I introduce in this podcast, is about self-awareness, and it's about acceptance, and it's about having agency. And having agency, in my opinion, includes knowing what we need and knowing what we don't need, which is driven, ultimately, by knowing our value and our meaning and our purpose. So that is a wide lens with which to open the conversation and for me to ask you, Melissa. How do you, as an expert in nutrition and eating and health, define health yourself?
Melissa: Well, that's a big question to open with. You're just going right for it.
Dr. McBride: We're going to go right from the top, and then we're going to get granular.
Melissa: [00:02:57] I had to do a piece recently for Oprah Daily where we talked about the concept of wholeness and what does wholeness mean to me, and I think that that can relate very nicely to this idea of what health means to me. So I think, very often, we look at health through a very narrow lens, and often, when it comes to diet culture, it's through the lens of body size. I mean, they are just absolutely equated that the smaller your body, the healthier you are. If you take a step back from that, maybe you're looking at health from the perspective of, "What does my diet look like? Do I have a movement practice? What does my sleep look like?"
[00:03:31] But even more than that, there are so many different factors that make up this concept of health or wholeness. I'm looking at it from a physiological perspective. So, do I have the energy to do the things that I want to do in my life to keep up with my kid, to do the recreational activities that make me happy? Do I feel satisfied from a personal development standpoint? Do I feel like I'm working on myself and I have the time and capacity to do some self-awareness or do therapy? Do I feel like I have a spiritual practice, whatever that looks like? Whether I'm connected to God or the universe or just my own highest self, am I cultivating that spiritual practice? Do I have social health? Do I feel like I have good connections with other people in my community? Do I feel like I have support? Do I feel like I'm not isolated?
[00:04:16] I think there are a lot of different aspects of health. You have to look at them from a position of wholeness. You can't just look at any one aspect, because one aspect can be going very, very well, but if all of the others are falling behind or you're not paying attention to them, to me, that doesn't feel particularly healthy or feel like thriving.
Dr. McBride: You couldn't have said it better, and it dovetails exactly with the way I think about health. It's not about the absence of disease. It's about the integrated sum of different components. It's about nutrition, body mechanics, self-awareness, which includes awareness of our medical vulnerabilities, which are often genetic and environmental, and it also includes, as I said earlier, that sense of agency. When I think of agency, I think of the ability to execute on goals that are yours and only yours. That's a luxury for a lot of people to have the opportunity to grow and to personally grow health-wise, grow professionally, grow relationships. But I think agency can also be on a really small level, feeling more in control of our everyday habits and even our everyday thoughts.
Melissa: [00:05:21] I agree. You know, when you say agency, I immediately think about self-efficacy, this idea that, like, I feel as though I am able to accomplish the things that I want, and sometimes that involves, if I think back to my recovery and the serenity prayer, giving me the patience to accept the things I can't control and, leave them out, but recognize that, for the most part, I do have control over how I choose to respond to those situations in that I usually or almost always can have agency. And again, there's an element of unacknowledged privilege in that statement alone, but we'll just say that agency, to me, does involve this aspect of self-efficacy and recognizing the things that I can't do while making strides on the things that I can.
Dr. McBride: [00:06:02] At the risk of repeating myself on this podcast, and my listeners may be, like, "Oh my God, there she goes again, talking about the serenity prayer," the serenity prayer, like, it's kind of the final common pathway of so many different conversations I have with patients, whether it's about parenting, like, letting of the fact that your teen doesn't want to talk to you right now and accepting that's normal for their age, and leaning into the opportunities, you have to talk to them when you're driving a car and it's quiet and there's no eye contact, to managing your addiction to alcohol, accepting you don't have control and leaning into the parts of your life that you do have control, finding joy and pleasure in other places and asking for help.
[00:06:40] I’d love to, therefore, pivot to the conversation about your addiction and your health, because you grappled with addiction to heroin, cocaine add other substances. And so I'm aware that you, like so many of us had enormous struggle as a younger person, and I'm imagining also that informed a lot of how you are today and show up today. Can you talk a bit about that process, not that that can ever be encapsulated in a quick podcast?
Melissa: [00:07:15] Yeah. I mean, you know, my drug addiction started when I was about 18, and it came as the result of some sexual abuse I experienced at 16 by somebody I was very close to. And I had just...you know, after that experience, I didn't tell anyone for a year. I didn't know how to handle it. When I did tell my family, they didn't respond super well. It was a really challenging situation that I was definitely not equipped to handle. And so I was looking for ways to essentially escape my own life. And I tried drinking, and that didn't work. And I tried restricting my eating, and that didn't work. And I tried dating guys who were terrible for me, and that didn't work. And it wasn't until I tried drugs that I was like, "Oh, this is it. Here we are. Here's the thing that can pull me so far away from myself." And I was addicted for...
Dr. McBride: Can I interrupt you for a quick second?
Melissa: Yeah.
Dr. McBride: [00:08:00] I'm going to guess you weren't aware at the time you were dating the wrong guys and restricting calories, that you weren't aware that you were self-medicating. You were just doing it. Or were you that aware of your own pain?
Melissa: I was pretty aware.
Dr. McBride: You knew what you were escaping, like, "Oh, I'm going to go, like, looking on a menu of things to self-soothe. And here they are."
Melissa: [00:08:17] I don't think I could go that far, but what I knew was that I did not want to be in my own life, and I was very actively looking for things that would take me away. I don't think I could have explained it any more eloquently than that at the time because I didn't have the language and I didn't have the tools. But I knew that I was hurt so much, and I didn't want to be there, and I was looking for something to take me out a bit. That was about my experience.
Dr. McBride: It's interesting because, as you know, sexual abuse, sexual trauma, is so common and so commonly ignored by all parties. Like, because it's so stigmatized and so shameful to talk about in people's minds, people often don't know they're self-medicating. They don't know until they're in a real bind that their alcohol use is related to that trauma. And it's not a lack of intelligence, it's just a lack of insight. So it's impressive to me that, at an early age, you knew your feelings and you just didn't have an outlet.
Melissa: [00:09:09] My sexual abuse was, like, a record scratch in my life. Up until that point, I was the good kid. I didn't get in trouble. I got good grades. I read a lot. I was quiet. Everybody liked me. But, like, I wasn't super popular. I mean, it was a very middle-of-the-road. Like, I was about as even-keeled as they came. And then, after that incident, everything went sideways, my behavior in school, I started acting out, my behavior with my family and with my parents, I started dressing differently. So, to me, it was very obvious that all of these things were related to this incident of sexual abuse, but I hadn't told anybody. So, to everyone else, it looked like it was coming way out of left field, but I knew what was happening.
Dr. McBride: You didn't want help in the beginning, right? You wanted to hold that boundary so tight that you weren't going to let people in. But, like, what happened? When did you get kind of caught or busted, or when did you get enough insight to know this is a real problem and affecting your everyday health?
Melissa: [00:10:00] Pretty dang early on, you know. I dove in as hard and as fast as you could. I didn't have a drug of choice, which I now know is quite unusual. I only dated drug dealers for five years. And very quickly, I realized that this thing that I was using to escape from my problem had now become a problem unto itself, and now I had a problem layered on top of problems.
And I was like, "Well, I'm this far in. I don't really know what else to do." And so this is the cycle that addicts get stuck in, whether you're talking about food addiction or drug addiction or alcohol. I overconsumed, and I hated myself for it. And I had guilt, and I had shame, and it led to isolation. And that led to stress, and that led me to overconsume the very thing that I hated myself for doing. And I was stuck in that cycle for a very long time because I didn't know how to get out of it.
[00:10:45] And it wasn't until I had this moment of, like, literal divine intervention with a boyfriend who was miraculously stable and wasn't a drug addict who gave me, essentially, an ultimatum and said, like, "You need to go to rehab. I can now see how problematic your behavior is and how much you're killing yourself. And, like, I really want to see you go. Would you consider going? And if you can't go, I'm going to have to leave. I can't watch you do this to yourself." And in that moment, I somehow found the strength to be, like, "Okay, I'll go."
Dr. McBride: That person set a really good boundary, and they knew what they needed from a relationship, and they were trying to use their own healthy boundaries to help you. It's just an important moment in your life.
Melissa: [00:11:21] He's my favorite ex-boyfriend, for a reason. I talked to him not that long ago. We texted, you know, just a couple of months ago, and I was like, "Hey, in my book, I'm still calling you my favorite ex-boyfriend." And he's like, "I will always cherish that," you know. But, yeah, he literally saved my life, and he did set boundaries with me. He set boundaries while I was using. He would say, "We can't have this conversation if you are this high. So when you come down, let's talk because we need to talk," or "It's okay that you stay out late, but you need to call me to let me know where you are. Otherwise, I worry." He tried to set boundaries for me for his own protection because I was destroying him and the relationship, and ultimately, that was what got me to rehab the first time.
Dr. McBride: [00:11:59] One of the things I find so interesting and this is getting really granular, is, like, what was it about him that allowed you to trust and receive that message? In other words, I'm guessing there are other people in your life who were, like, "Melissa, get a grip. Melissa, you're sick. Melissa, you need help." What's interesting to me is, like, the messenger in that moment and who has access to someone who needs help and who needs to make important changes in their lives. And I wonder what it was about him that gave you the kind of confidence and openness to receive that message, given that I'm guessing other people had said similar things.
Melissa: [00:12:33] It was the moment. I remember very clearly sitting on the couch. I had just been paid. My money had been... Because I was very functional as an addict. I still had a job. And I had just been paid, and all the money was in my bank account. And I remember him saying, like, "I need you to go to rehab, or I'm going to have to leave." And I remember calculating how much heroin I could buy with the money that was in my bank account and knowing, if I did that, that I would die, and not really caring that much, and having just a split second moment of "You could have something different." And in that split-second moment, I was like, "Okay, I'll go." And faster than I could even take it back, he was on the phone. He found me a bed. Like, I say it was divine intervention because it really feels like that.
Dr. McBride: It also sounds like he wasn't judging you or shaming you.
Melissa: No. He was sad for me. He knew who I was earlier in my addiction. I was always using when I was with him, but I was nowhere near as bad off as I was at the end. He really hated to see me do this not only to our relationship and to him but, like, mostly to myself.
Dr. McBride: [00:13:28] In order to access other people and their willingness and ability to make changes, whether it's around food or other habits, to me, the messenger has to be free of judgment and someone they trust and then lead with empathy and curiosity. I find that if I'm counseling someone who's an addict on not just the benefits of quitting alcohol for them, because people often know the health benefits, but the other possibilities of how their life could be going and what other root causes that underlie this self-destructive behavior, coming at those conversations with blame, shame, and declarative statements does not go well.
[00:14:12] In fact, I don't recall ever having a conversation with anybody, including my kids and my spouse, about changes, from doing the dishes or whatever, that landed well when you lead with shame, blame, and declarative statements. But, hey, I wonder if you could connect the dots between the way you relate to alcohol to that childhood trauma you told me about, similarly, I might say to my kid. I wonder if you thought about doing the dishes as part of the family unit. In other words, questions instead of declarative statements.
Melissa: [00:14:42] There was nothing at that point that anybody could have said to me in terms of trying to shame me or blame me or disparage me that I wasn't already saying to myself 10-fold. Nobody could ever say anything to me that would be worse than what I had said to myself. And at that point, I was really struggling with, like, do I even have any worth or value left if I do enter into recovery? I'm going to have so much harm to repair. I'm going to have so much life to rebuild. It really did feel hopeless in that moment. But, you know, I had so much privilege, again, going into my recovery.
[00:15:17] I had a family who had not abandoned me. I called my mom from rehab, and she was, like, shocked and upset. And she was, like, "Okay, let us know when we can come visit." I had a boyfriend who was there and ready to protect me. I had a decent job with health insurance so I could go through rehab and spend time in counseling and have that covered by insurance and a job who said they'd hold my job for me. Like, in terms of my recovery, I had everything going for me, and all I needed to do was show up and do the work, which is so much more advantage than so many other people have.
Dr. McBride: [00:15:45] One hundred percent. And I'm sure you would agree that if everybody had access, unfettered access to mental health services, addiction, and rehab services and had a doctor, a nutritionist, priest, rabbi, who could talk about addiction in a matter-of-fact way, lead with curiosity and empathy, and know that the person they're talking to is already filled with shame, and then we could talk about mental health issues like we do any other physical health issue, we would be in a world of a better place.
Melissa: It would be a very different environment. You know, I've been in recovery for almost 23 years now, so this was a very long time ago. We are much more free now in talking about mental health, in talking about recovery, in talking about addiction. There's a lot of destigmatizing that has gone on, at least in certain circles, right? If you're on those sides of TikTok and Instagram, people are very free, and you're even seeing it at the highest level of media, you know, when you have champion tennis players talking about taking a break or gymnasts talking about taking a break for their mental health. It is now something that we are effectively working to destigmatize. Twenty-three years ago, it was even harder. So I want to continue to see the progress that we have made, and I want to see that progress continue to increase.
Dr. McBride: I totally agree. And I think, as I say to patients all the time, when we talk about mood or anxiety and they're kind of wondering why I'm asking, I remind them, we all have mental health. It's a feature, not a bug. It's something that you either address or you don't address.
[00:17:15] And to you, Melissa, I'd love to ask you next, how did your mental health and recovery process inform the decision to start the Whole30? And how did the lessons you learned about yourself in recovery inform how you talk about food?
Melissa: There's so much recovery language built into the Whole30 that I did not even recognize when I wrote it, but other people who were also in recovery would show up at a seminar and they'd be like, "Are you a friend of Bill W.?" And I hadn't talked about my recovery for the first year or two that I was running Whole30. And I was like, "How did you know?" And it was like, "Oh, it's, like, these six terms and phrases that you've used in these seminars." When I got out of rehab the second time, because I had a year of recovery and then I relapsed, which is very common, and then the second time I, [00:18:00] you know, entered into recovery, I realized I had to change everything about my life if I was going to maintain my recovery.
[00:18:05] I needed to become a healthy person with healthy habits immediately. I had to adopt that identity, create that growth mindset, set in whole boundaries with other people and myself, and that was when I started going to the gym and eating healthier. I made a new group of like-minded girlfriends who ran instead of drank, and we would go for morning runs instead of go out for drinks at night. And I changed everything about my life. And that led me to, in 2009, this 2-person self-experiment that was to become the Whole30. And, you know, for 30 days, we eliminated foods that are commonly problematic to varying degrees according to the literature to see if they were problematic for us.
[00:18:44] And while I experienced incredible physical benefits from that Whole30 energy, sleep, mood, performance in the gym, recovery, the most important thing that my first Whole30 did for me was identify the ways that I was using food like I used to use drugs, as punishment, as reward, to self-soothe, to cope, to relieve anxiety, to show myself love. I didn't have any other coping mechanisms. And it wasn't until I took those foods away for 30 days that I was like, "Oh, crap, I have to figure out how to sit with discomfort and not automatically look to food or drink to, like, numb or run away from that." And my behaviors with food were relatively healthy. I wouldn't call them incredibly dysfunctional, but I came away from that first Whole30 with so many more tools in my toolbox. It radically transformed, permanently transformed, my relationship with food. And that was such a powerful experience that I was like, "Okay, I wanna tell other people about it and share about it."
Dr. McBride: It's incredible what you've done. I mean, I was just in the grocery store earlier this week, and I'm looking at a label on something, and it had a Whole30 label. I'm like, "Oh my gosh, that's my podcast guest."
Melissa: I know her.
Dr. McBride: [00:19:49] Yeah, that's cool. I mean, it's extraordinary what you've done, particularly, the nuanced way you talk about food. Like, I notice, even just when answering my question now, you don't talk about eating healthy. You talk about eating healthier, meaning, it's all relative. It's not a black or white, on/off, kind of binary system you're talking about. The way this shows up in my office as a primary care doctor, as you imagine, I have people who ask me about, "How do I lose weight?" all the time. And some of them need to because they have metabolic syndrome, diabetes, you know, heart disease, high cholesterol, the various consequences of extra weight or poor health habits. I also have patients asking me all the time, "How do I lose weight?" And they don't need to lose weight. It's more of a body image, you know, often informed by kind of the subtle cruelty of diet culture that infiltrates the minds of women more than men, but women, in particular.
[00:20:42]So I guess my question to you is, given that the Whole30 does involve elimination and sort of draconian measures in the first 30 days of no sugar, no alcohol, no caffeine, no gluten, no dairy, how do you talk to audiences about the harms of restriction, balanced with the benefits of understanding exactly what you're putting in your body and the emotional, physical, and medical effects of them?
Melissa: I mean, this is an incredibly nuanced discussion, because diet culture and anti-diet culture are just two ends of, like, a very long spectrum.
Dr. McBride: You said it.
Melissa: [00:21:22] The Whole30, as we've alluded to, is not a weight loss program. We are not a prescriptive approach in that Whole30 doesn't say, "You should eat like this forever." We also don't categorize foods as good or bad. There are no good or bad foods, and you are not good or bad when you eat food. We remove all morality from the equation. What Whole30 is is a self-experiment, because any medical doctor or registered dietitian will tell you, there is no one-size-fits-all when it comes to diet. You have to figure out what works for you. And your patients say, "Yes, that makes so much sense, of course. How do I figure out what works for me?" And so Whole30 is the answer to how.
[00:22:02] It's a 30-day elimination diet, and elimination diets have been around since the 1920s. Many medical doctors still consider them the gold standard for identifying food sensitivities. What the Whole30 does is it eliminates foods for 30 days that are commonly problematic to varying degrees across a broad range of people. We pull these foods out for 30 days and see how the elimination of these foods impacts your energy, your sleep, your mood, digestion, cravings, joint pain and swelling, acne, allergies, asthma, anxiety. All of these conditions can be impacted by the food that you eat. At the end of those 30 days, you'll reintroduce those food groups one at a time very carefully and systematically, like a scientific experiment, and compare your experience.
[00:22:48] Based on what you learn through the Whole30, you will then have a blueprint for how foods work for you and your unique context, and you'll be able to take that to create the ideal sustainable diet for you according to your definition of health. We don't prescribe that for people. As you've mentioned, there is an element of restriction to Whole30, which is why we don't suggest the program for people who have a history of disordered eating or eating disorders. Any program with restriction can be triggering, so we are very open about that and very encouraging of those folks to work with a qualified healthcare provider to see whether or not Whole30 or some modified version of Whole30 might be right for them and make sure that they're completing the program with supervision, if at all.
However, when you look at most weight loss diets that involve restriction, you're talking about restriction maybe of entire food groups but also specifically of calories. And when you restrict calories and either macronutrients, micronutrients, or both, that obviously sets the body biologically for that rebound effect that almost always happens at the end of a weight loss diet, because you are underfeeding yourself, undernourishing yourself. The Whole30 does not have that aspect. We don't count calories. We don't restrict calories. We don't restrict portions. We're eating three, four meals a day to satiety, real whole nutrient-dense food.
So, from that perspective, you don't have the same physiological rebound effect to the restriction of calories on the Whole30 that you might have with other plans, which can help people feel more satiated, more satisfied, and not deprived for those 30 days if they choose to take on this self-experiment.
Dr. McBride: You explained that so well. In practice, as you might imagine, I see lots of patients who undertake diets for the wrong reasons, or they're well intended, meaning, like, they actually need to lose weight because they have type 2 diabetes and they need to lose 50 to 100 pounds, but they haven't set themselves up for success because they haven't fully understood what a program can and cannot do for them. For example, there are certain diets, which will not be named, that basically give you fake food, and indeed, you will lose 10 pounds to fit into the mother-of-the-bride dress in 2 weeks. But you will inevitably feel ashamed when you can no longer keep that up, because who can eat fake food unless you're a robot, and then you gain all the weight back.
I have patients all the time who are valiantly trying to lose weight without connecting the dots between the real parameters of their everyday life and setting themselves up for failure by saying, "I'm gonna chop vegetables. I'm going to prepare a protein-rich meal and quit alcohol in perpetuity." And then, if they have a full-time job, and they've got kids, and they travel for work, the wheels fall off the bus. In other words, what I see being successful in practice is when a patient's expectations are managed for what a behavioral change can and cannot do for them when it comes to food or anything else, when they have a healthy respect for behavioral patterns that are paved like concrete highways in their brains that are hard to break up, and they're willing to alter habits, and they have the time, energy, resources, space to make changes, and they're not looking just at the number on the scale. They're looking at the metrics of how do I feel, how's my sleep, how's my energy, how's my poop, how's my sex drive, how's my ability to concentrate at work. And when people can take away that obsession with the number on the scale and even their A1C diabetes test, which we need to see, but isn't the end all, be all. When they look at how they feel and how they are in their bodies, then people are setting themselves up for success in a sustainable way.
So what I like about Whole30 in the way you described it is that, yes, there are gonna be people who use it for the wrong reasons, people who don't need to lose weight and are starving themselves not just for 30 days but for 60, 90, 100 days. But when a patient is given the framework within which to think about this change, and they are looking at the right metrics, it can be successful. It can be a knowledge exercise. It could be an exercise in understanding what works for their bodies.
Melissa: It's a huge exercise in self-efficacy as well, because it's not easy, right? And here's the thing, we know that people come to the Whole30 and say, "I know you're not a weight loss diet, but I'm still trying to lose weight." And it's like, "Okay, I respect that. You have the right to do with your body as you choose. That's not my business." But if they stay connected to Whole30 through any medium, whether they're reading a book, they're on our social media feed, they're watching my YouTube live, they're getting our email newsletters, you are getting every single moment of every single day focused on no-scale victories, "Here's your Whole30 mindset and how it differs from your old diet mindset. Here's how you can restore that connection with your body and learn to trust the signals that your body is sending you, because your body knows better than any calculator on an internet how much you should be eating." Those are the messages that you're getting.
We invite people to take a well-deserved 30-day break from hyper-fixating on that number on the scale as your only success metric and look at all of the other benefits that changing the food you put on your plate can bring into your life and what that does for literally every area of your life. The Whole30 is about food, but it's about so much more than just food. And when people do the program and they feel that sense of self-confidence and self-efficacy, the only benefit you had from the Whole30 was that you ate really good whole food for 30 days, like, you know, nutrient-dense, vitamin-dense, micronutrient-dense food for 30 days, and you kept a promise to yourself. I would call that a home run.
Dr. McBride: One of the harms, in my opinion, of diet culture, mixed with hustle culture, mixed with social media, mixed with just the modern world, is that so many people have lost touch with hunger and satiety cues. In other words, patients commonly will say to me, "I've cut out alcohol. I've cut out gluten. I'm not eating as much overall, and I can't lose weight." If they actually need to lose weight, I will talk to them about what the cadence of your eating is like during the day. Because sometimes people aren't losing weight as they want to and need to because they aren't eating enough. They aren't in touch with their hunger and satiety cues. And I think when we're busy, when we're eating on the run, when we count coffee as breakfast, a KIND Bar as lunch, and then we don't eat all day because we're so busy, and the floodgates open at 7:00 at night, we lose track of what does it feel like to be hungry and what does it feel like to be sated.
I don't know if this resonates with you, but I talk with patients commonly about hunger being, [00:29:30] like, a wave. You're gonna notice it rising. I'm not a surfer. But you notice it rising, and you notice it about to crest, and that's when you wanna eat. If you're tangled with your proverbial surfboard in that crashing wave, you're going to overeat, you're going to overeat the wrong stuff, and then you're going to feel bad about the next day. But if you can understand your cues, which often get lost in our everyday lives, that can do so much good.
Melissa: I mean, it's not just that they're getting lost. It's that, if you have been weight loss dieting, you have conditioned yourself to not pay attention to those cues.
Dr. McBride: That's right.
Melissa: Your body says you're hungry, and you're like, "No, you're not, because I don't have any points left today," "No, you're not, because you can't eat lunch until 1 p.m.," "No, you're not, because you just ate your 100-calorie snack bar, and that's the only snack that you're allowed to get." So there are a lot of experiences, especially for women, that disconnect us from our body. Maybe it's religious influences. Maybe it's diet culture. Maybe it's trauma. But we lose that connection, and then we're told over and over again that we can't trust our own bodies.
Dr. McBride: [00:30:30] One hundred percent.
Melissa: So one of the biggest benefits of Whole30 is, like, restoring that connection and saying, like, "Yes, you can trust the signals that your body is sending you and to start to tune back into that."
Dr. McBride: Yeah. I mean, so many of my patients who are in recovery for disordered eating, we talk a lot about just trusting the neck down again. This is not, like, the CEO and then your body is the, like, chief operating officer, right? It's not supposed to take marching orders from your brain in its rigid form. It is integrated. Your body can actually give you all the information you need, and your body is your friend. If I had one message to give patients who are struggling with weight or relationship with food, it's, first, try to get back in touch with your hunger and satiety cues and give yourself permission to notice hunger and to feed yourself and to be sated. Satiety is one of the best things for calming anxiety, for focus, for concentration. It's normal. And pleasure is not something we should be avoiding. Even if it's by eating a chocolate bar, that's okay.
Melissa: [00:31:29] Absolutely. You know, I talked earlier about how I used to cope all the time with food with self-soothing and relieving anxiety. And I still do that sometimes in a very conscientious way, and it still feels good. And I feel good about it, but that is no longer my only coping mechanism. And I think that's the difference. I now have a therapist, and I talk about my feelings with my husband and my friends, and I journal, and I walk, and I hike, and I meditate, and I reparent, and all of these other coping skills that now are just this, you know, nice, holistic picture of ways that I relieve anxiety and discomfort and self-soothe. Food is still one of them, but it's not the only one. And I no longer have the shame or guilt or negative self-talk associated with it. And I think that's the difference.
Dr. McBride: You are really on the other side of that recovery, and I love what you just said, which is that recovery includes pattern repetition, repetition compulsion. As long as you know that that's happening and you forgive yourself for having dessert or you open a pint of ice cream because you're sad and you eat it, like, that's okay. That doesn't mean you're "relapsing" or morally flawed or gonna gain 100 pounds. It just means you're human.
Melissa: Yeah. I mean, the other day, I was having a really hard mental health day, and I said to my husband, "Today is the day that I'm gonna skip the gym, I'm gonna sit on the couch, and I am just gonna eat whatever comes up for me." For me, on a normal day, those might be seen as not healthy behaviors. Skipping the gym is, like, not typically what I do, because I love going to the gym. But on this day, that felt like the thing that I could do that would nourish myself the best, and I was still conscientious and deliberate in how I chose to do it. I loved every second of sitting on my couch, watching Netflix, eating Smartfood Popcorn, and then, when it was done, I was like, "Okay, all right, that felt good. But that's not sustainable, and I don't wanna do that again tomorrow. What am I gonna do tomorrow? Because I still don't feel great, and although that was nice, I need another tool from my toolbox." And that's what I did.
Dr. McBride: You're so wise. One of my favorite expressions is this, and I actually just used it with my daughter who is feeling guilty about saying no to something that, in my opinion, and I think in hers too, would actually help, she's, like, a classic perfectionist, an achiever, I mean, she's the best thing since sliced bread, but I said to her what I say to my patients, which is, "Saying no to something means saying yes to something else." Saying no to going to the gym that day because you didn't feel like it is saying yes to the permission to be a blob. And that's healthy.
[00:34:00] I mean, if you say no all the time, like, "No, I can't turn in that term paper," "No, I can't participate in that sporting event," "No, I can't show up at school," that's a problem. But this comes down to what you talk about in your new book about boundaries, knowing what your needs are and having a diverse portfolio of things you can turn to to manage the inevitable stress and distress that life brings.
Melissa: You know, we were, just a moment ago, talking about this idea that it's in our best interest to check in with ourselves and ask ourselves, "What do we need? How are we feeling? Are we hungry? Are we full?" and that we can trust the signals that our bodies are sending us. That applies equally to this idea of setting and holding boundaries. So often, in our lives, we look to everyone else to tell us how to show up, how to behave, what to do, when to be there, how much to give based on their expectations, and again, very rarely are we encouraged to and we're basically never taught to pause and say, "Hold on just a second. What do I need? What would I be comfortable with? How do I feel about this?" And then respawn from that place of self. And that is really at the foundation of my boundary practice. You don't know where you need to set a limit to keep yourself safe and healthy and protect your energy and mental health and time unless you are able to check in with yourself and assess what your own needs are.
Dr. McBride: This is exactly why I think you and I both love our mutual friend Elise Loehnen. She's, like, a Buddha on this stuff. I love the way she talks about and you talk about knowing your north star, knowing what you need from relationships, from food, from the world to be healthy, and then giving yourself permission to ask for it, and then not apologizing for having needs. I think, in the world we live in, men too, but women, in particular, often suffer from this, like, sort of self-sacrifice as a badge of honor, as subjugating our needs, as being altruistic, when, from my own experience and from working with patients for 22 years that always blows a gasket somewhere. I mean, there's anger, there's resentment, and then we'd end up meeting our needs in other ways that aren't maybe so healthy.
Melissa: [00:36:07] Yes. We have been conditioned. Women, and especially moms, have been conditioned by the patriarchy and stereotypically rigid gender roles and religious influences and diet culture to be small, to be compliant, to put everyone else's needs and feelings above our own. We are praised the most when we are not even on our own list, and then when we do ] have a need, we either hint around it because we've been told we can't ask for what we need directly, because that's rude, or if we do ask directly, we are called the B-word, or we're told that we're cold, or selfish, or we have too many rules.
There is this conditioning in society around how a woman and how a mom is supposed to show up, and there's a lot of unlearning we have to before we can start advocating for ourselves and setting boundaries without feeling guilty. Because when I set a healthy limit that is designed to improve our relationship, I am not doing anything wrong, and there's nothing to feel guilty about. But I've got to unlearn all of that other stuff that tells me that I should feel guilty for simply existing and having needs.
Dr. McBride: Amen. Hallelujah. As you might have guessed, I am an oldest child, I am a woman, I'm a perfectionist, I'm a pleaser, and I had to unlearn a lot of lessons that weren't even taught to me by my own family but just by society and living in the world I live in. And what's been "fun," [00:37:30] although, let's be honest, painful as well, is setting boundaries as a grownup and feeling how it's working and not working, and then seeing the net benefit of setting boundaries, whether it's with another person or with habits or behaviors, and then feeling the discomfort of setting that boundary, like, maybe disappointing someone or saying no to something everybody thought you'd go to or declining something else, and then seeing how you're actually really paying it forward for your own health and well-being and actually nurturing relationships by saying no. Because, then, that person knows what your limits are, what your boundaries are. And then, if that person's meant to be in your life, they have a better understanding of your needs.
Melissa: Yeah. You know, boundaries are such a gift in relationships. They create such a sense of safety in relationships, because the other person knows that I am going to take responsibility for my own feelings and needs. So if I say to them, "Hey, I'm really going through something right now. Can we talk?" and they say, "Oh, I can't talk right now. I'm in a meeting,"
[00:38:30] I'm not just gonna wait around for them to be free and dump my problems onto them. I'm gonna say, "Okay, thanks for letting me know, because I respect your boundaries." I really need to talk to someone right now, so I'm gonna go call my therapist. I'm gonna call my mom. I'm gonna call my sister.
If you say to me, "Hey, Melissa, do you wanna do this podcast with me?" and I say, "Sure, I'll do that with you, but I don't really have the time or capacity," and I'm saying so resentfully, and then I'm showing up for this interview, and I'm distracted, and I'm not prepared, and I'm kind of all over the place and scattered, and then you're wondering, "Well, she said yes. Why is she showing up like this? Maybe I did something wrong." No. If I say yes to you, you know I say yes authentically, and I'm going to show up as my best self and my most prepared, and I'm not going to be resentful, and I'm not gonna show up begrudgingly. And if I say no, that's a gift, because you know that I can't give you what you need right now, and you'll go find another podcast guest that's gonna be better than I can right now.
So boundaries are really this clear, kind communication that improves your relationships, and when you can shift and start to see them like that, they no longer feel selfish. They no longer feel like something you should feel guilty for.
Dr. McBride: [00:39:30] It's such a good message. It's so important. It's exactly what I try to teach my kids. Because when you don't set a boundary, you end up paddling in gossip. Your love language can be resentment and, "Wow, look at her. Look at how she's so important." If you don't set a boundary, you end up doing things that go against the grain of your own integrity, and that is intrinsically uncomfortable. And if you're not honoring that discomfort, it's going to show up in another way.
The other thing, on the flip side of that, is there are some times you had to do things you don't wanna do, right? Like, you know, sometimes you just have to turn in the term paper even though you don't want to. You sometimes have to say yes and participate on that sports team because that's the way the world works to be able to make the team. I think the question is, knowing your place in the universe and knowing how to advocate for yourself in a healthy way, you know, that's something you have to learn the hard way, I think, in this world.
Melissa: You know, what I find is that when people live in boundaryless relationships, [00:40:30] they are walking around resentful, they're walking around anxious, they are dreading interactions, they're keeping people at a distance, which hurts the relationship. If my mother-in-law keeps dropping over without calling, and I don't say anything to her because I'm trying to be nice, so I open the door and I'm like, "Hey, Carol. Yep, come on in." And then she comes in, and I'm cold, and I'm short. And I don't wanna visit because it's not a good time, but I don't wanna say so because I'm trying to be nice. And she's like, "What did I do? Like, what is wrong?"
Boundaries [00:41:00] can be uncomfortable. It can be uncomfortable to say, "Hey, Carol. Would you please call before you come over and give us about an hour's notice?" That can be uncomfortable. But what you're doing now is already uncomfortable. You're walking around anxious and resentful and dreading certain interactions, and your relationship isn't going well. And eventually, if you keep holding that in, you are going to explode. And, like, that path doesn't get you anywhere. That's just a circle of doom and unhappiness. And the discomfort of setting a boundary can be momentary but lead to this huge [00:41:30] improvement and expansion of your relationship. And that's the discomfort that I'm willing to go through.
Dr. McBride: I mean, mic drop. Passive aggressiveness is also a byproduct of absent boundaries or wobbly boundaries. We all know when we're being passive-aggressive, and we all know when we're the victim of passive-aggression. And to me, that's a signal that, you know what, it's time to be honest about what's happening here without blame or shame, but just name and own your part of the boundary that was broken. Say, like, "Look, I realize I showed up at a time that was not convenient for you. I hope that next time you just let me know if it's not a good time," or "Hey, I think I might have asked you a question that made you uncomfortable. My bad. So sorry." And then let them talk, right? Just being honest and authentic. And that's a tall order in the world we live in.
Melissa: It is, especially, again, because women, especially, are taught to talk around everything. We're not taught to be direct. We're taught to hint and to hope that people read our minds, and then we get disappointed when they don't do the thing that they didn't know they were supposed to do. And then it just goes back and forth and back and forth, right, and then you end up in these fights where, like, your husband is like, "Hey, can I go out with the guys for a drink tonight?" And you don't want him to because you have a million things to do, but you go, "Sure." And he thinks you don't mean it, but he doesn't really wanna hear it, so he just leaves. And then he comes home three hours later, and you're in full-on rage mode. And you're like, "How could you go out? I really needed you home." And he's like, "You said it was okay for me to go." And I can't tell you how many times in my past lives those cycles had [00:43:00] repeated until, finally, I was like, "Oh, clear communication is kind." And if everyone just said what they meant, relationships would instantly get 78% better.
Dr. McBride: Like, that little story resonates with me 100 times over, by the way. Anyway, it's all so healthy, and these are sort of, like, the infrastructure that we all should be thinking about putting into place in our regular lives, because it's like the skeleton we need to be healthy and happy and to be honest with ourselves. What are you working on? I mean, you've obviously reckoned with addiction. You've reckoned with boundaries. You've reckoned with a conversation around food and bodies in a public-facing way and in your own life. What's on the frontier for you now?
Melissa: You know, I tend to take on self-improvement efforts or self-experiments as they come up for me. I'm not a new year's resolution person, so I don't think ahead of time, "Oh, I'm going to work on this this year." Right now, I'm heavily invested in my own mental health, so I typically have, because of my post-concussion syndrome, combined with winter, I typically get really serious seasonal depression. And this year, I don't have any, and so I'm like, "Okay, what am I doing? How can I keep it up? What are the practices I've put in place that are really helpful?"
So I'm kind of really diving into that and making sure that I'm caretaking for my mental health. And then I feel like I'm in a season of work right now where I'm thinking about how can I rebalance my work and my life. I've had a period of hustle where I just put this book out, and that was a year and a half of really intense writing and touring and media. And, like, maybe it's time to rest a little bit more, and how can I incorporate some more rest into my life? So those are two things I'm focused on right now that I think are going hand-in-hand.
Dr. McBride: You're just trying to be intuitive, it sounds like, and not plan for the inevitable ups and downs. And then it also sounds like you're trying to breathe in and consciously note the conditions that allow you to feel good.
Melissa: I build in moments many times a day every single day to check in with myself, "How am I doing? What do I need?" I do these meditations where I talk to parallel timeline Melissa, "How are you? You're doing amazing out there. What have you done to get yourself there? Like, talk to me about it." I talk to 16-year-old Melissa. I represent myself in these meditations where we talk about what she was feeling and what she was going through and, like, where we are now and how good we're doing new. I have all of these built-in sort of touch bases that I learned in therapy and through my own practices, and I'm constantly checking in with myself to be, like, "What do you need? How do you feel? Where would you be comfortable?" I act on those.
Dr. McBride: [00:45:28] I love it. And then I think, as we focus on self and self-actualization, self-discover, and health, and well-being, we then bring that improved self to our parenting, to our work, and to the world, because we can often confuse effort to know oneself and check in with ourselves as indulgent. When I look at it as the opposite, it is a way of nurturing self to then present to other people, because, to me, and I think to you, being other's focus is a way of maintaining meaning and purpose and satisfaction.
Melissa: I am not a people pleaser. No one would ever describe me as a people pleaser. I am a firm believer in paying myself first. When my cup is full, when I am nourished, when I am fed, when I am well rested, when I am happy, when I am taking care of me, I have so much more to give to everybody else in my life. And that giving feels more authentic, it feels more organic, it feels more joyful. I do this for me. But by extension, that allows me to do things for others.
Dr. McBride: [00:46:30] You're awesome, Melissa. And I'm not saying that just so you like me. What I think is so unique about you, Melissa, is that you're not only writing and speaking and talking to people about health, you're modeling behavior and vulnerability and authenticity and the ability to be forgiving of ourselves when we make mistakes. You're walking the walk, not just talking the talk. So I think you're helping people just by being yourself and by sharing your story, which ultimately is, I think, an important way of affecting behavioral change in others. So thank you for joining me. I'm thrilled that you came today.
Melissa: It is my pleasure. Thank you so much for the conversation.
Dr. McBride: Thank you all for listening to "Beyond the Prescription." Please don't forget to subscribe, like, download, and share the show on Apple Podcasts, Spotify, or wherever you catch your podcasts. I'd be thrilled if you like this episode to rate and review it. And if you have a comment or question, please drop us a line at info@lucymcbride.com.
The views expressed on this show are entirely my own and do not constitute medical advice for individuals. That should be obtained from your personal physician. "Beyond the Prescription" is produced at Podville Media in Washington, D.C.
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