Gender-Inclusive Care, Queer Joy & Naturopathy with Dr. Arlie Millyard ND

In this episode of Wellness Unpacked, host Tisha is joined by Dr. Arlie Millyard (she/her), a naturopathic doctor specializing in LGBTQ2SIA+ wellness and gut health. They delve into the intricacies of queer inclusive care, the impact of stress on the gut, and the importance of a body-neutral approach to health. 

Dr. Millyard shares her personal journey into naturopathic medicine, the significance of understanding intersectionality in healthcare, and practical advice for advocating for one's health in potentially non-affirming healthcare environments. They also discuss the common health concerns within the queer community, the role of resilience and community in wellness, and strategies for managing IBS and nervous system dysregulation.

02:33 Journey into Naturopathic Medicine

05:08 Understanding Naturopathy

07:07 Inclusive Healthcare for LGBTQ2SIA+

10:31 Challenges in Traditional Healthcare

13:47 Navigating Healthcare as a Queer Patient

19:56 Health Patterns in Queer and Trans Folks

24:36 The Gut-Mind Connection and IBS

34:02 Understanding Body Neutral and Weight Neutral Approaches

36:37 Toxic Wellness Culture and Its Roots

40:32 Addressing Stress and Nervous System Dysregulation

43:00 Vagus Nerve Stimulation and Gut Health

46:53 Incorporating Joy and Community into Wellness

57:01 Creating Safer Spaces for Queer People in Healthcare

01:00: Daily Rituals for Nervous System Regulation

Connect with Dr. Arlie Millyard

Website: https://arliemillyard.ca/

Heal All Consulting: https://healallconsulting.ca/

Instagram: @dr.arlie.nd

Follow Tisha
Website: nourishedwithtish.com
Instagram: @nourishedwithtish
Tiktok: @nourishedwithtish

Transcript

 Welcome to Wellness Unpacked. I'm your host,  Tisha,  your gut and hormone nutritionist and TMI bestie. I help people like you to improve their hormones, gut health, and their relationship to food and their bodies using an inclusive and anti- diet lens. Join me as we deep dive in a conversation about diet, culture, hormonal health, sexual health, and let's be honest, the topics that maybe we're too shy to bring up anywhere else.

Follow me on Instagram at Nourished with Tish, and make sure to subscribe to the podcast so you'd never miss an episode. Let's dive in. Welcome back to the podcast. I am really excited to be diving in to today's episode with you. I'm joined by Dr. Arlie Millyard, a naturopathic doctor. Who has so much good information to share in today's episode.

I knew early on I really wanted to have her on. In fact, I think I reached out maybe a year ago to invite her onto the podcast to talk about queer inclusive care and how the unique experience of being queer, of being trans shows up in our health needs in our bodies, and how we can navigate the often tricky, frustrating experience of trying to find inclusive healthcare.

And Arlie is so unbelievably knowledgeable. I feel like we also ended up diving into gut health and nervous system dysregulation and how that impacts our gut. And I just think there's so many good takeaways here and I'm sure you're going to love this episode. So without further ado, let's dive in and let me introduce you to our guest, Dr. Arlie Millyard. So Dr. Arlie Millyard is a naturopathic doctor, LGBTQIA plus wellness advocate and gut health Nerd Arley helps folks who feel alienated and unseen and health and wellness spaces work towards wellness on their own terms so they can feel comfortable and empowered in their bodies. With her neuro affirming body neutral approach, Arley calms fussy stomachs and sensitive nervous systems getting to the root of your health concerns with her individualized strategies.

Creator of the best paced method for complex chronic fatigue, Arlie is dedicated to making compassionate integrative evidence form care more accessible. So welcome, Arlie. Welcome to the podcast. I am really pumped to be diving into this topic today. Thank you so much for joining me. I was hoping, um, maybe to start, you can share a little bit about your journey into naturopathic medicine and what led you to specializing in queer health.

Sure. Yeah. So I was pretty lucky to realize that I wanted to become an ND pretty early on. It was between my first and second year of university and at that point I had only realized that I was queer and been out for, I don't know, two, two or three years. Um, but I had already had some one really amazing affirming experiences in healthcare and some experiences that had made me feel horrible about myself, mostly at my university clinic.

And more importantly, I had friends, particularly trans friends who were full of stories of being refused care because of their identity. Um. So by the time I started my degree in naturopathic medicine, I knew that my personal dream was to create a practice where queer folks could just get really good healthcare.

And then it was only when I was in school that I realized that I needed to also teach other wellness practitioners how to do the same. So I, uh, feel pretty lucky that I get to do both of those things now. I love that. Um, I'm curious what got you into Naturo naturopathic medicine to begin with? Yeah, I mean, I was one of those, um, teenagers who was, you know, really good at science and everyone would constantly ask me, so you're going to become a doctor?

And I was like, no. I just knew that I did not wanna be a doctor. I think my excuse at the time was like, I don't wanna help people, which is. So silly and like such a funny, like, teenager thing to say is obviously the opposite of how I feel now. But I think that there was just something about conventional medicine that I knew was not right for me.

And, um, then as I went to university and started working more on myself to, you know, maybe work on adding a little bit more empathy to how I felt about how I wanted to see the world, I realized that I did wanna help people and actually medicine was a good fit for me. I just needed a different approach.

And it, it came to me honestly as a light bulb moment. I had a friend who wanted to be an anesthesiologist and she was complaining to me about how bad her period cramps were. And, um. I was like, oh, well you should like drink this tea and like eat a banana, like do some yoga or something. And she was like, I was just gonna pop an Advil because I'm an aspiring anesthesiologist.

And I was like, okay, well what does that make me? And literally light bulb. And that afternoon I like googled the prerequisites for naturopathic college and, and got them in my schedule for the next year. Amazing. It sounds like a very natural fit. Yeah. Uh, could you explain, maybe if someone doesn't quite understand what naturopathy is, can you explain what that is and how it differs from conventional medicine?

Yeah. So naturopathic medicine is a. Healthcare profession in Ontario, it's totally regulated as a healthcare profession. Um, that is essentially focusing on preventative care using natural medicines. So our toolbox is pretty big. We will use botanical medicine, lifestyle counseling, um, and nutrition. So exercise is part of lifestyle counseling, um, traditional Chinese medicine and acupuncture, hydrotherapy, um, physical medicine.

So we have a wide range of options to us that are natural types of modalities that we use to help people. Get to the root of their, their health problems in, uh, an integrative way. And that often means considering preventative health, so long-term health and helping people manage chronic conditions. We can also do acute care as well, but, uh, I tend to focus more on those like chronic health conditions that people really need help managing and maybe don't get the type of support that they need, um, from their primary care provider.

Um, so lots of nds practice in lots of different ways because we have such a large toolbox. We all tend to reach for different things in that toolbox. But, uh, the basis of it is all of those more natural types of therapies. Yeah. Yeah. And I feel like one of the benefits too is to see amount of time you get to spend with a naturopathic doctor.

You don't always get that time with conventional doctors, so that's great. Yeah, a hundred percent. My initial appointment with folks is 90 minutes. So we get to actually understand who that person is as an individual, um, and how all of their health concerns fit together, which is something that is really lacking in those like seven minute appointments that people get with their gp.

A hundred percent. So you mentioned before that you actually spent time educating other practitioners on what gender affirming and inclusive care looked like. Can you first describe what that is? And then second of all, can you say, can you just share a little bit about how that first started for you?

How you got involved helping other practitioners? Yeah, so I now have a side of my business called Heal All Consulting, which is, uh. Organization that helps other wellness practitioners build more inclusive practices, specifically for lgbtq plus folks. But, um, or we try to be intersectional. Um, and it really just started because when I was in school, I couldn't help but put my hand up and ask questions of my professors when they left queer health or queer people outta the conversation.

And so my classmates started realizing that I was the person to go to if they had questions about this, they would, you know, come up to me after class, ask me for clarification. Or if they, in our intern year, if they had, um, a case that they didn't really know how to handle and their supervisor didn't really know how to handle because the supervisors didn't necessarily have experience with queer health either, they would come to me and, and ask me for my advice on it.

And at that point, I was just one queer person with my own experiences. I didn't necessarily have. All of the, you know, the research or any additional education to be able to support people in that. And so I realized that there wasn't a resource that people could go to for that. And I teamed up with another ND who was doing some of that work at the time.

And so we created this resource with, we now have four courses available that people can take for continued education credits. Um, I do workshops, I speak at conferences. Uh, I help people with their, like social media and intake forms and websites to make that more inclusive. It's if that's something that they want to do.

Uh, so yeah, I sort of stumbled upon it, but it's now something I think is a really important part of what I do, because I know that the work I do with my patients makes such a big impact on them, and I don't wanna be the only person who can provide that kind of care. Yeah, absolutely. And it's interesting 'cause I think this is true across different health sectors.

I know I see it in the dietetic space too, that queer people are often just slipping through the cracks and there's not a lot of education there. Yeah, absolutely. I think I had one course that in my four year naturopathic degree that really explicitly included queer people in the conversation. Um, and then we had one class, one, two and a half hour lecture on queer health, um, in my third year that was specifically focused on queer health.

And that's, that's just not enough to get people who are growing up in a cis heteronormative society to be able to then work with all types of patients when they graduate. Absolutely. Yeah, and I definitely think there's also this confidence gap that happens with practitioners who don't actually get to work with cases and see how that shows up in real life situations.

So Absolutely. Yeah, that was what I heard most often is like, I want to support these people. Like I think this is important. I wanna be able to do that, that I don't feel confident that I can provide that kind of care without causing harm because I just don't have the context. Yeah, absolutely. Yeah. The work you do is so important and I love it so much.

That's very fulfilling. So, beyond education, what are some of the biggest gaps that you see in traditional healthcare when it comes to queer and trans folk? Oh my gosh. I mean, this is such a big question because I think that a lot of people do think about the, the gap that there is as being just about clinical knowledge.

Like, oh, all I need to do is learn how to. Prescribed gender affirming hormones, and then I'll be a queer inclusive practitioner. But it's actually, most of it is not about the specifics of the care. It's about how we interact with people, the words we use, this space we're in. So whether the clinic has an all gender bathroom available, uh, about the standard operating procedures, whether the reception staff is trained in working with diverse patients, uh, there's so many things that people just wouldn't know that it's a problem unless they are queer themselves.

Uh, and there's not that many queer healthcare providers because there's barriers unfortunately to, uh, more marginalized folks becoming healthcare providers. Yeah. Yeah, absolutely. I agree with that. If a patient or client is looking for a provider, is there any advice you have, um, that can kind of point them in the direction to let them know if a provider is truly queer affirming?

Yeah, so this is interesting because I think that a lot of providers think that they can slap a rainbow flag on their door and, and call it a day. And obviously that is something that many of us look for as a sign that somebody is safer to open up to, um, those visible markers like someone wearing a pronoun pin or a rainbow lanyard.

Those can be small signals that are reassuring, I will say. But I think the more important proof is in the pudding, like the early signs that somebody has actually done the work are that they have an actual statement on their. Social media or website that's not just platitudes. It like really shows an understanding that the queer folks need a certain type of care.

Um, that they have intake forms with gender, sex pronoun questions that actually make sense instead of just being like, well, I threw these on here and I don't understand how it works. Um, and then when you're in that interaction with somebody that they use neutral language. So for example, they're at, they'll ask about partners.

They'll use gender neutral pronouns until you say something that is more specific and then they take on the language that you've said because they're paying attention. So those are signs that I look for that are a little bit more subtle. And, uh, I think that those are the things that are maybe a little bit harder to look for and are a little bit harder for, uh, practitioner to start displaying unless they have a deeper understanding.

And so if they're doing those things, it probably means they get it. Yeah. And I also know it's not always possible to find these providers who, you know, maybe especially if you're living in a small town or something, like maybe that option isn't available to you. Um. So I'm curious in those instances, how can you advocate for your own safety or even just correct a provider if they've made a mistake and how do we, I already know, like for a lot of people, we already feel so uncomfortable, so it's like, is there a way to, I'm sure you probably have some, some good dialogue or some good, uh, phrases that people can use, but yeah, what's your advice in regards to that?

Honestly, I could talk about this for three days. I recently started trying to write a blog post about this, and it spiraled, I think it's already turned into three blog posts now. I literally am thinking about writing a book about this because unfortunately we're in the healthcare system that we are in, and we still need to be able to learn how to navigate that system effectively.

So there's so much to think about there. First, just understanding how the healthcare appointment that you are going into works and what is expected of you, I think is the first thing. Um, just in terms of getting what you want out of an appointment and not expecting too much. I wish we could expect from expect more or hope for more, but, um, right now we need to kind of work within the constraints that we're in.

And then I do recommend that everybody, especially when they are working with a new practitioner, thinks about what their comfort level is with coming out to their practitioner, and then maybe practice how they are going to share that or they, how they would correct an assumption if something comes up.

So when it comes to deciding whether you're going to do it. In a lot of cases, that's going to be a balance between how comfortable, how safe you feel doing that and needing to share that information if it is clinically relevant, because there's situations where you're not necessarily going to feel safe or great about sharing that information, but that doctor does need to know that information.

And unfortunately, you do need to share it even if you don't feel amazing about it. But if you can practice how you're gonna do that and be able to say it in a confident way, um, that can, that can go far. Uh, and in the situations where you're deciding that you're going to share this information, that's something where you have a little bit more of an opportunity to practice and feel good about that the way that you're communicating it.

Uh, and if you're correcting an assumption. I think a lot of us feel this need to take care of the feelings of the practitioner who's made the assumption or take care of the awkwardness that has come up, um, by maybe making a joke about it. But I would say it's more important to be clear, to be crystal clear about what you're communicating than to be cute or funny or, or likable in that moment, because I know this has happened to me where somebody has made an assumption.

Usually it's that I'm straight or that because I'm married, that I'm married to a man and, uh, like, because it always still takes me by surprise when people make these assumptions. I feel like I'm never prepared. To say specifically, here's the actual information that you need to know. If you, what you are trying to get at right now is asking whether I'm pregnant, there's no possibility that I'm pregnant, I do not have sex with anybody who could get me pregnant.

Um, and that is a clear way to say it. Maybe there's like a gentler way to say it that would feel a little bit cozier, but I think it's important to practice those, uh, those clearer ways because ultimately it is your doctor's job to get the clinical information that they need. And it's, it's more important to communicate that than it is to like feel cozy about it.

A thousand percent. That's such a good point. And I think unfortunately it does put the burden on queer people to try to figure out what it is the doctor is asking and what information they're looking for. Frustrating. And this the problem, the only reason this is coming up is because. Practitioners are not asking questions in a clear way.

And so it's unclear what kind of answer you're supposed to give. And yeah, if, uh, if doctors actually ask questions in a, in a completely neutral way that just specifically asked what they needed to know, then we wouldn't be running into this problem. But unfortunately. That is still the norm. And to be fair, all healthcare providers are just people as well.

They have their own biases and we have to navigate those situations the best we can. Of course. Absolutely. Um, I'm curious, I can think of so many examples in my head, but do you have any examples of a question a doctor might ask that is really vague and how we might respond to that? Oh, I mean, the classic is are you sexually active?

I mean, what does it mean? Like why, why do they need to know? Um, I don't think I have ever asked that question in my however many years I've been practicing because I just need to know more specific things. So are they trying to find out if there's a possibility that you have a STI is, are they trying to figure out if there's a possibility that you're pregnant and if, if you're actually not sure why Dr.

ZA question, you can ask that before you answer it, and I recommend that. Um, because then you'll be able to give a clearer answer and you won't have to share things that you necessarily, you don't necessarily feel comfortable with. Um, the, the question of are you sexually active can get muddy. It can get into lots of things that may be difficult for people to answer.

Uh, you know what? If somebody has never had a consensual sexual experience, but they have had some kind of sexual contact with somebody in their life, that's then you're opening up a whole can of worms. And that's not a trauma informed way to ask that for that person. Um, so it's best to be very clear about why, uh, why you're answering a question.

Um, and that also can save you from having to get into things that may be distressing for you. That's such a good point. Um, I'm curious, in your practice, are there any unique health considerations or maybe recurring patterns that come up more frequently in your work with queer and trans folk?

Interesting question. So definitely, um, I would say the, this thing that I have to say before I get into this is that, um, because historically and you know, to this day queerness has been seen as a medical condition. Um, it's important to note that any patterns or any health conditions that I see that are more common in this population, it's not because your identity has made you sick, it's because of more systemic things that are going on.

So let's talk about those patterns, having gotten that out of the way. Um, and there's tons of overlap as well with. Other folks who are, are not queer, but this is, these are the patterns that I see. So, in particular, I see a lot of IBS, irritable bowel syndrome, a lot of burnout, a lot of chronic pain with queer and trans folks.

And there's a very clear reason for all of these. The burnout is because a lot of queer folks are neurodivergent and living in a world that doesn't suit how your brain works is exhausting. The chronic pain is sometimes related to hypermobility, which is also more common among A DHD and autistic folks.

So because there's a higher percentage of queer people who are also neurodivergent, you have that overlap that increases, uh, the prevalence of chronic pain related to hypermobility, but most often digestive issues and chronic pain. So chronic pain like headaches, menstrual pain, fibromyalgia, are all nervous system related.

Uh, and that is such a complex thing, but it's kind of one of my favorite things to talk about. Yeah. Let's, let's dive in a little bit. What is that connection, uh, between stress and our nervous system and how does that show up in all these symptoms you just mentioned? Yeah, so there's abundant research that shows that being part of a marginalized group is stressful.

There's a concept called minority stress and it describes four different reasons why being marginalized is stressful. There is an active stigma, which is actual experiences, discrimination, uh, that happen in the world. Then there's anticipatory stress, which is having had experiences of enacted stigma in the past or having heard from members of your community that they have experienced these things.

You then anticipate what's gonna happen if I come out to my healthcare provider, what's gonna happen if I go into this space? And all of that. Worrying about that is stressful. Then there's the stress of having to conceal your identity in order to stay safe in certain situations. And then there's internalized homophobia, transphobia, uh, which unfortunately is a byproduct of growing up in a world that feels that way about your identity.

And I think it is intuitive that when somebody has a lot of stressful or harmful or even traumatic things happen to them. They develop anxiety, right? Their brain learns to anticipate harm, and it works over time to try to protect them. We understand that that's how that works, but many people don't realize that the brain is only one part of the nervous system, and other parts of the nervous system develop the same protective mechanisms, so that can make you very sensitive to pain in the body.

So whether that's abdominal pain, pelvic pain, headaches, something else, the nervous system becomes very sensitive as a protective mechanism when it has been exposed to chronic stress. Wow. Yeah. It's amazing. It, it's wild the way, the way our bodies work. And to your point, I think a lot of people feel, you know, maybe a lot of shame when they have anxiety and feel like it's outta their control or that they should be doing better to control it when really it is this protective mechanism.

Like this is a very real and normal response. Yeah. To the stimuli, to the environment, to everything that's going on around you. Yeah, absolutely. I think we often think of anxiety as something pathological, right? Your response to this situation is outsized. It's not real. It's not based on reality, but it, like you said, it's a protective mechanism.

It is a completely reasonable thing for your brain and your body to do that in order to protect you. It's taking care of you. Yeah. Okay. Maybe we can touch on coping mechanisms in a moment, but I wanted to ask you, 'cause you did mention IBS before. Yeah. Can you talk a little bit about the gut mind connection and why all this stress, why this would show up as IBS?

And also for anyone who doesn't know, can you explain a little bit about what IBS is? Yeah, absolutely. So, IBSI, irritable bowel syndrome is, uh, typically the symptoms that people notice are abdominal pain that's associated with changes in bowel habits. So that can be that somebody has a lot of urgency, more like diarrhea.

It can be that they're more constipated or that they swing back and forth between both. And it can be really, really stressful because you have to now think all the time when you're going out, where's the bathroom? Can I eat this? Will it trigger my symptoms? So it's really stressful for a lot of folks.

And IBS is a classic example of this process that I just described where the part of the nervous system that's affected in IBS is the enteric nervous system, which is the nervous system of the gut. It's a huge, complicated nervous system, sometimes called the second brain because it controls the digestive processes without us having to consciously think about them.

Uh, and what happens with IBS is that just like I described, it can get sensitized. So if you have had an experience, particularly where your digestion has been thrown off in some way, like you got a stomach bug at some point, or maybe you do have a food allergy or something has happened that has been a threat to the digestive system, even if that threat goes away.

It sensitizes the enteric nervous system. And so it, that can cause the nervous system to react more strongly to even very small stimuli that normal functioning, enteric nervous systems would not care about at all. And then that can lead to that bloating and that abdominal pain, uh, and that urgency. Uh, and that can also happen higher up in the digestive tract.

Um, so for example, a lot of heartburn, uh, is actually a similar effect that's just happening in the stomach, so higher up in the digestive tract rather than down in the intestines. And the good news about this is that, that sensitization can be reprogrammed. So it's not just that you have to have ideas forever.

I, it makes me so sad when people talk about just like, well, you know, hot girls stomach problems, I'm just gonna have this for the rest of my life. It's totally treatable actually. Yeah. Okay. I, I love this. I have a couple co. A couple follow up questions for you. So what is your go-to? What is, what is the initial strategy we're taking, especially if you have deemed that maybe there's a stress component that is really affecting your IBS?

Oh my gosh. So with IBS, my approach is to start by just chilling everything out as much as we can to start with. So basically giving your enteric nervous system a little holiday, and we do that, uh, with whatever tools are most appropriate for the individual. So for some people, that is figuring out if they do have specific trigger foods and avoiding those for a short period of time.

I never do long-term restrictive diets, but sometimes we do need to remove some things that are causing immediate problems. Um, with a plan to reintroduce them. Sometimes that's using a medication or herbs to help calm down that digestive tract. And the, the goal of this is that you should only need short term where you're kind of babying your, your, your digestive tract.

And then we start reintroducing things and getting you to a point where you actually can tolerate things that used to be difficult to tolerate. Uh, and then rebuilding the, the health of the gut. So, um, retraining the nervous system so that it doesn't start reacting to things again. And building up the healthy microbiome, the healthy, uh, bacteria that are supposed to live in the gut because we would not want those to be negatively affected by any treatments that we use, which sometimes.

Can affect the microbiome. Absolutely. I love all of that. Um, so when you talk about eliminating foods, the first thing that I'm thinking of is a low FODMAP diet, because I think that's like often what people go to for IBS. Can you talk a little bit about why it's important that we're not just eliminating foods for good and why we wanna be bringing them back in?

Yeah, definitely. So there's kind of two main reasons. One is pretty simple and that's that the low FODMAP diet is what's often recommended for IBS. And that's 'cause it works. It works very well. We have lots of research showing that if you cut out this very large set of foods, you will feel better, uh, at least in the short term.

The low FAP diet is a very low fiber diet. It is very low in prebiotics, which are the fibers that feed those good bacteria that live in your gut. And if you cut them out long term, those bacteria are gonna start to suffer and you actually need those bacteria. Um, not to mention that low fiber diets are associated with higher risks of colon cancer and all sorts of things.

Um, so we don't want anybody on such a restrictive diet like that just for the health of your gut long term. But I would say almost more importantly, when we avoid foods and we start building fear around foods that can sensitize the enteric nervous system even more. And that can mean that it's even harder to reintroduce those foods, even if there is no physical reaction that the body is having to it.

That fear around that food, um, can cause so much stress to the enteric nervous system that you do end up reacting to it. Uh, and so that's why having as little time as possible in a restrictive diet is, is so important. Um, and a lot of folks who are not really given much guidance or are just told. By, let's say their gastroenterologist, Hey, you should try the low FODMAP diet.

And then they're on it for like five years and then they come to me, have a much, much harder time reintroducing those foods. Um, and it's not because those foods are bad for them, uh, or are unhealthy in any way, it's just because of the negative associations that have been built up with, uh, the reactions that they get or that they fear getting when they eat those foods.

Yeah. Uh, I think that's such a good point. I feel like it is very common for someone to just be given a handout told to, you know, to remove all these foods from your diet. And that is the end of it. And I, I know people to this day that are, have been on low FODMAP diets for years and they just think that they can't have these foods.

And of course, the more we restrict, the more we find we have less tolerance for foods. And it feels like that I. That window just gets smaller and smaller. Yeah, absolutely. I'm curious if in your practice do you deal a lot with individuals, especially in the queer community who struggle with restrictive dieting with body image issues?

Um, is that something that comes up for you and is that something you're keeping in mind when you're giving food recommendations? Yeah, absolutely. I think it's interesting because a lot of the ways that restrictive eating or body dysmorphia comes up in queer communities looks a little bit different from how it often does, and so it often doesn't get picked up by practitioners who aren't looking for that.

In particular with trans folks that it's so intertwined with dysphoria that even some eating disorder competent practitioners don't understand how to tease those things apart. So that's one part that I think it's important to pay extra attention to. And then, because I'm a body neutral practitioner and I'm very explicit about the fact that I don't promote weight loss, I never recommend that my patients lose weight.

I think I probably have a little bit of a self-selecting population of folks who do have past experiences of disordered eating or, um, you know, you know, yo-yo dieting or. Experiences from childhood where they were told that they had to lose weight even then when they were still growing or, you know, horrible things like this.

Uh, and so just being able to offer body neutral medicine where we're not trying to change the way somebody's body looks, we're just trying to help them feel better, uh, has resonated a lot with the queer folks I work with. But also the reason I started practicing in that way is that I know what it is like to go to the doctor and to not be listened to because of, of who I am.

And, uh, as a thin person, I do not know what it's like to not be listened to because of the size of my body, but the, the feeling that you come away with is similar and I just don't want anybody to feel that way when they leave my office. Yeah. Oh, I love that. That's so important. Um, for anyone who doesn't know, can you explain a little bit about what a body neutral approach is and what a weight neutral approach is?

Yeah, so body neutral, weight neutral are terms that are used to describe medicine where the goal is not weight loss or there's less of a focus on weight loss. Um, it totally acknowledges that people have bodily autonomy and if they want to lose weight, if that's one of their goals, they totally can. But I, as a practitioner, am not going to be the one who is pushing that.

Um, and so instead we use other measures of health other than BMI and weight. Instead, we focus more on lab values, imaging, how they feel, what they can do. And these are things that are generally a lot more empowering as well. And so a lot of people feel a lot more motivated to stick to their treatments when those are the things that they're working towards.

And it's obviously a lot more appropriate for people who have histories of eating disorders as well, because then we are simply not talking about the things that can be triggering for them. Uh, and, and that is obviously totally individualized. Different people have different triggers. Uh, and that's part of it for me as well, is getting to know what something, what care that is less triggering or that is body neutral actually looks like for that individual so that we can make sure that we're just doing the things that actually have a, a positive impact for them.

There's, I think an interesting distinction between weight neutral and body neutral. Weight neutral is really focusing on the weight side of things. Body neutral I think was added in with a consideration for disability justice because a lot of disabled people find that when they go to the doctor or any kind of healthcare provider, what is expected is that they must want to be cured, uh, or that there's something wrong with their body because of their disability that they should fix or change or they should want to get better.

And a lot of disabled people are like, actually this is just my body and I don't need it to change. Here's the things that I actually wanted help with. If we could focus on those. Um, and because I've worked with a lot of folks with chronic illness where we don't expect that they're gonna be cured, I think that bringing in that entire body neutral approach is important for me.

Yeah, absolutely. Oh my gosh. Okay. You've brought up so many good points here. Um, I want to ask you, because you work in this alternative wellness space, we do tend to see, um, this kind of. Toxic wellness culture. And I, I'm just curious how you navigate that when there really is this quest to be the best version of yourself, the healthiest version of yourself, and often that is rooted in ableism in white supremacy.

So I'm curious if that is something that you see a lot, um, in your field, in your practice and how you navigate that. I mean, I see it constantly and I think that unfortunately any larger industry in our society is gonna have been heavily influenced by, if not completely rooted in those same values that are currently dominant in our society.

The white supremacy, the colonialism, the diet, culture of it all. Um, and so it's something I'm always actively thinking about. Where did this specific thing come from? There's even things that I know are very evidence-based that I just don't use that much because I don't think that the values behind them actually suit what my patients need.

Can you give an example of that? Yeah, it's so, I mean, the biggest example is weight loss. Like there is tons of research on weight loss. There is unfortunately, and it shows in those studies that it helps with all these outcomes. And yet looking at the bigger picture, I am so convinced that it is not the answer for the majority of people.

And then there's things that are sort of in the middle where there's really good research. I think there is merit to it, and the way that it's talked about, I think is inappropriate for my patients. And so I reframe it. We still use it, but we talk about it in a different way. For example, resilience. Um, resilience is so important.

I do think that people really do need to build resilience and it helps with so many things, but often it's sort of thought of as this thing that we just have to build from within or like mind from inside of ourselves. And we have this personal responsibility to be resilient regardless of what's happening around us.

And I think we need to reframe that from a personal responsibility thing to how can we be resilient against the stressors around us by including community care or by acknowledging the realities of what's happening and not just spiritually bypassing it. Uh, and so I think that there's room for both of those things of, of rejecting.

Something like weight loss that I don't think is something that I wanna include in my practice, while also understanding that people have bodily autonomy and can choose to lose weight and can choose to work with me while they do that if they want to, you know, understanding that there's tons of research on resilience and also wanting to reframe that in a way that is more aligned with the values of the people that I work with.

Yeah. Yeah, absolutely. And in thinking about the weight loss piece too, I know, um, I was doing research for PCOS the other day and even the research where it does show a beneficial, like a benefit to weight loss, I feel like the research is still super mixed on how to achieve that weight loss. Yeah, exactly.

How to keep that weight off long term. So I, I feel like it's, it's really just poor advice in general because you're giving somebody a tool that is probably unattainable short term, let alone long term Absolutely. And very detrimental to your mental health. So I think those are such great points. Um, maybe we can bring it back for a little, a little bit and talk more about this stress and nervous system dysregulation piece, and maybe you can talk a little bit about how you can support your nervous system and maybe how that shows up in a naturopathic setting.

Yeah, for sure. So I. I love this because I feel like I, I incorporate this in almost every case. Uh, there's so few people who genuinely have no stress in their lives, and there's so few conditions that are not impacted by stress. So first of all, reiterating what I just said. Basically, we're not just trying to ignore the real stressors in their life.

We acknowledge those, and every naturopathic doctor has a different approach to this. Personally, my approach, sort of big picture is to start by stabilizing things, soothing the nervous system as much as we can in the current situation. And we can use herbal medicine for that. We can use supplements if that's something that is indicated.

In that case, we just. Do our best to kind of stop that spiral just to start with, keep things stable for a minute. And then once we're in that place where they have hopefully a little bit more space to do the things that really get to the root of things, we can start adding in tools. We can start addressing whether that person has any sensory stressors that we can start working on.

We can do really practical things in their life to take those stressors off their plate. We can get their mom to babysit two days a week so that they have some time for themselves. Uh, and I actually spend a lot of time with people really practically talking about, okay, what are the things that are stressing you out right now?

What are the resources that we can pull in to help you with this? And then once they have some of those tools under their belt, then we start to build resilience. So making sure that they're sleeping well, making sure they are nourishing themselves well, making sure they're getting movement in that, that fuels and supports their body.

And I do those later in the process because first you have to make sure that that person has literally any time or energy to start doing some of those things that take a little bit more effort from them. Yeah. Yeah. I love that. Um, I want to quickly ask, 'cause we were talking about IBS earlier. Um, what are your thoughts on vagus nerve stimulation and is that anything?

Do you incorporate any of that, like, I know, like plumbing for your gut, anything like that? Yeah, it's so interesting. I mean, there's so much research now on the vagus nerve, but I also think that a lot of the recommendations that are kind of thrown around in wellness spaces are kind of not based on much.

Um, so there's so little harm to asking someone to hum that. I do do that sometimes, but I do try to focus more on the more evidence-based options. And specifically for IBS and heartburn in particular. Uh, what I encourage a lot of my patients to do is die pragmatic breathing, because this does possibly, we think, activate the vagus nerve, but it also physically massages the stomach and it activates the diaphragm, which is the.

Giant sheet of muscle that separates your thoracic cavity, where your lungs are from your abdominal cavity, where all of your digestive organs are, and your esophagus has to pass through the diaphragm in order to get to the stomach. And that hole in the diaphragm where the esophagus passes through is the valve that separates the esophagus from the stomach.

And so diaphragmatic breathing helps to activate that valve more effectively. Uh, so it just has so many benefits that, uh, and we do have actual research showing that diaphragmatic breathing helps. Um, that that's the one that I tend to go for over things like humming or singing or what other, whatever other hacks people do.

I don't know, putting a weighted blanket just on their sternum. There's a lot. If those things feel great, then great do it. Uh, that's also. Part of a lot of what I do is sort of balancing where is the evidence and also what else can we consider evidence other than scientific research. Your own personal experience absolutely counts.

Traditional knowledge absolutely counts. And so how do we pull those things in in a way that is balanced and actually gets good outcomes? Yeah, yeah. A thousand percent. Um, I'm curious with the people that you work with, if you see a lot, uh, I'm just thinking, I don't know how, I feel like Gen Zs are a little bit of a different generation, but I'm just thinking to uh, to my millennial self that a lot of queer people I know often use smoking and drinking as coping mechanisms, um, to deal with their identity.

And I'm curious if that shows up at all for you and your practice and how do you navigate that? Yeah, absolutely. We have a large. Bodies of research showing that this is a thing, that there are higher rates of smoking and of binge drinking in queer populations. And that is directly correlated to the level of minority stress that people experience.

Uh, so it's, it's because of the stress, it's not because of the identity. It's probably not even because of the culture. Uh, it's, it's a coping mechanism. And whenever that is something that people are engaging with, I always spend way more time thinking about and talking about. Stress and how we can manage that in other ways before trying to change those behaviors.

Because if they're doing it, it's because it's an effective coping mechanism for them. Maybe it's not healthy for them long term, but they need something to deal with the stress of the world. And so can we add in other tools or change some of the things going on in their life so that they are less stressed before we try and take away this thing that is soothing for them?

Yeah, absolutely. And that kind of brings me to my next question is what are some of those things that we can do to incorporate more joy into our life, maybe more community, and how can we approach things like movement and nutrition in a place of self-love versus self-loathing? Yeah. Oh my gosh. So this is sort of a more complicated question than it sounds.

I think because we are so used to this idea of self-care as like a thing that you just do and like, oh, just take a bath, just take a blah, blah, like easy done. Whereas I think that the actual process is that we, it needs to happen, especially if your queer body is a difficult place to live in. First you have to make your body a safer place.

The body itself, address any pain that's going on in there. Um, improve any things that are making you not able to eat certain foods, right? Any food intolerances get those health problems themselves managed. Then once that's done, hopefully that means that you have more capacity, that you have more freedom to add in the good stuff.

Um, and hopefully you can add in the good stuff, the joyful stuff as early as possible. Um, I work with a lot of people who have chronic fatigue syndrome, myalgia, encephalomyelitis, which completely takes your energy away. I mean, people barely have the capacity to get through the day. And so they're dropping a lot of things that make them happy.

And a lot of the research says, well, what people should be doing is graded exercise programs where they, um, you know, start working out and then they increase their exercise on a very strict schedule. And that is part of my strategy way down the line. But before people start doing that, as soon as people have any extra capacity, any extra energy in the day, I want them to start adding in things that make them happy, that bring them joy.

So I think that that is so important to realize how, how crucial joy is in, in our health, uh, and obviously in our life, but it is important in our health. It's not, you know, just something that you do on the side because, because it's fun. Um, and if some of those things are hard for people, the, the things like movement, rest, nourishment, these things that we know do give people energy.

Um, sometimes that comes from a place of past experiences of, of diet culture or of being told that they need to exercise so that their body looks a certain way and things like that. Um. And sometimes just having a practitioner who can talk about these things can talk about movement and nourishment in a way that leaves weight outta the conversation, um, or actually gives real good reasons for doing them.

Um, sometimes that's enough for people. For some people sometimes it's really hard to unlearn those associations. Uh, and I often work alongside people's mental health therapists to get them to a place where we can approach movement and nutrition in particular. Those are tend to be the more triggering ones in a way that actually feels nourishing instead of feeling like it's coming from a place of shame or that they have to do it.

Um, so that's one of my most important collaborations is with mental health therapists because, uh. It is a real barrier that people face and yeah, we, it, it's such a shame to not be able to access some of those things because of the way that like wellness culture or diet culture has, has taken some of those things away from us.

Yeah. Yeah. You bring up so many good points, and I think it's important to know too that weight stigma is very real. It makes a lot of sense why people seek weight loss, why they want weight loss. Like if you, especially if you're someone who's already struggling with elements of your identity, I feel like adding on additional stressors, addit, additional discrimination, I, I think it, it makes a lot of sense.

Like that feeling is very, very valid and so I think honoring those feelings, honoring the fact that that. It's coming from a real place. It's coming very much from a reaction to a culture that might not accept you or might actively harm you. Mm-hmm. Um, no, I think that's, I think that's such a good point and I think something similar happens, although a little bit different.

I mean, I hear this all the time when we try to get people to just like, chill out for a second. Just rest. Everybody I have ever talked to struggles so much with feeling okay with just resting because of this capitalist society we live in. I mean, it's really hard to just relax without feeling like you should be doing something.

Yeah. So I like to talk about the difference between resting and recharging. Sometimes there is so much shame about resting and people really struggle to do it, and, and that in itself is a problem. But sometimes the problem is just that people are boy bored, like they d. Just retting, just sitting around is not appealing.

They don't wanna do that. They also don't wanna be like lying and scrolling on their phone for three hours every night. Uh, that doesn't seem good. But they also don't wanna be just lying on the couch and not doing anything. Um, so we have to figure out is there something else that you could be doing?

Like maybe, maybe you just need a hobby. Maybe we need to think about being able to have hobbies without having to monetize everything that we do. Like maybe you can just do something for fun and not feel like you have to do it. Ugh. Yeah. I feel like I relate to so much of what you just said, especially this last piece of monetizing a hobby.

I think I like. I know so many people are guilty of that. You learn a skill and you're like, well, if I can get really good at it, I can now sell this and profit. And of course, it is very much a product of this capitalist society that we live in. And also, to your point earlier you mentioned this idea of the fact that we are just a hyper individualistic society too.

Mm-hmm. And so this idea of self-care is very much rooted in how can you buy self-care? Like, can I, mm-hmm. Can I buy the face mask and the bath bombs and the massage? And so there's already a level of classism that comes with that, with privilege that comes with that. And so I think being able to find things that, you know, that feel good to you, that nourish your soul, that you know, help you to relax that aren't always rooted and not, not to say that, you know, you can't have a massage, like go get your massage, but.

But also there, yeah, there, to your point, there's so much that we can be doing, um, that hopefully doesn't cost too much money. And, and I think also being able to find spaces for community and being around other people is so important. Absolutely. And I think this is something that is a lot really hard for a lot of people to navigate because community is amazing.

And if you're not already embedded in one, it can also be really anxiety inducing. It can be really hard to make new friends, especially as an adult, it can be really hard to know whether a space that you're going into is a place that really shares your values. It can be hard if somebody has social anxiety.

It's hard if you don't like, it's hard for everybody. And especially I think in, um, in 2025. I myself, especially as somebody who works with a lot of people with long COVID, um, I'm seeing how hard it is for people to navigate different levels of comfort, around risk, around infection. And it's something that makes it really hard for people to build community, um, at this, at this time in the world where we, we crave in person connection, but we also don't always feel safe in, in-person spaces.

We're all so bored of being online all the time, but sometimes those are the places where you can find people who are really your people. And so it's, it's really difficult to navigate nowadays, and yet I think it's so crucial to our health and happiness and survival. Yeah, of course. I know. I think TikTok really is this double-edged sword where on the one hand you can commute, you can connect to people that maybe you wouldn't have been able to otherwise.

And I feel like so many people have learned so much from TikTok, but on the other hand, it feels like you can just be doom scrolling for hours on end, seeing the state of the world. And that doesn't feel particularly good either. Yeah, a hundred percent. And this is one of those things where when I'm talking to people about, well, there's very real things in the world that are stressing you out.

Like, absolutely, let's acknowledge that. Let's validate that, and you have access. To the news 24 7. And that is more than your brain was designed to be able to handle. Yeah, especially when it's like the news globally. Yeah. There's still going on every minute of the day. It's a lot to take in. It's like very overloading for our nervous system for sure.

Okay. I'm curious if we bring it back for a minute. What are some things that you think practitioners or providers could be doing better to create these safer spaces for queer people? I know we touched on it a little bit earlier, but was there anything else wanted to add? But I think that, um, it's important to think about what is it beyond clinical care that you can do better?

I think we should be focusing on our systems, our policies, our procedures, our EHR platforms. It's not the obvious stuff because it's behind the scenes, but that is why it's important, is because it is behind the scenes. It. Supports everything that actually happens in the encount, the clinical encounter.

And so we should be training our staff because an appointment with a great affirming practitioner can be ruined by a bad interaction with a receptionist. And we should be thinking about all of the things that actually are involved in the patient experience. Yeah. A thousand percent. Can you touch a little bit on, um, on your, on your training, um, that you, that you give to providers and how that might be beneficial for them?

How that can help them be. Better practitioners. Yeah, sure. So we have four courses and then I also do workshops. And the first course that I recommend that people start with is foundations of LGBTQ two i plus inclusive care. And this goes through what I consider to be the five elements that are important for being an inclusive practitioner.

So that does include the clinical skills, um, but it also includes the systems that you use. This your space. It includes addressing your biases and it includes understanding intersectionality. And so even for somebody who is in this space who understands queer health, I think it is helpful to see it all in a framework like that because it's really, really easy to miss elements, even if we are.

Queer providers ourselves, we only have our own experience to go off of, and so doing training can actually be really helpful to be like, oh, there's actually a ton of other letters in that acronym that I could understand more about and that I could be supporting better. Um, so I would always start there, uh, if somebody is interested in doing some training, and then if that is something you enjoy, then go on to our, our more advanced courses.

We have one on a neutralizing clinical language, which is what I was talking about earlier with, uh, you know, starting with really neutral words, gender neutral terminology, um, and then individualizing your language for the patient sitting in front of you as you go. And it's a really specific skill that we were not taught in school.

I certainly wasn't. Um, and so I think that is one that I highly recommend that people learn. My co-founder and I made a handout on this that has been taught in medical schools. Uh, it is, it's really caught on because I think it's a skill that all healthcare providers should have. Absolutely. No, I think it's such, such important work.

Um, and I agree. I feel like most healthcare professions very much lack this training, so I absolutely love that. Okay. I feel like I could talk to you for hours we didn't even get to. I wanted to ask you about talking about neurodivergence, so maybe we'll have to have that conversation. Another, oh my gosh, I feel like that bringing me back, I think I'll have to, there are so many things I wanna talk to you about, but Okay.

Being mindful of your time, I think we'll end it on one last question. So this one's for you. Do you have any daily rituals or practices that you like to do to help you just connect to your body, to regulate your nervous system and feel good? Yeah, I, um, I do really benefit from structure in my life and I also am someone who needs a fair amount of novelty.

Um, so there's not that many things that I have done the exact same way over an extended period of time. I. The only one really is that I go outside to drink my free glass of water every day. Um, it's kind of a meditation. Um, if you're familiar with the concept of a sit spot, this is where you meditate in the same place, usually outside, um, repeatedly general, not necessarily every day, but over the course of season so that you can observe how that place changes.

And so I kind of get the opportunity to do that just while standing on my stoop and drinking my water. And I think because my brain craves novelty a little bit, um, I never get bored of it because within six weeks, which is when I would normally get bored of doing a routine the same way, the weather is totally different.

Like the season is different, the plants that are blooming are different. Uh, and that's something that has really served me well. I started it because I wasn't drinking enough water and I wanted to post reminders on Instagram for other people to drink enough water while simultaneously reminding myself, and it's become this really amazing thing that I'm probably gonna stick with like for the rest of my life.

Yeah, and you know what, it is a really good reminder because so often I see on your stories and I'm like, oh yeah, you should really hydrate right now. Yeah. It's a reminder sometimes for myself that I'm like, oh, I've, I need to step outside today because I know once I get to work, like I'm not leaving the house for hours.

Yeah. This is my other thing is that it's just one very short period of time that I'm guaranteed to go outside. And because I work from home three days a week, um, on those days I might not leave the house. Um, and so I know that at least I've gone out once. I have been going out. Two times a day, almost every day lately, because we've also been going out to look for neighborhood cats after dinner, which I highly recommend.

It's a great after dinner activity. That's so fun. I, yeah, I love that. That's great. Um, so in the summer we do that as well, but yeah, especially in the like cooler seasons, it's so easy for those of us who work from home to, to not leave the house. So having some consistent reason to do that is really important.

And now I could get into talking about the importance of importance of nature, time, vitamin N. You are gonna have to bring you back for two more minutes. I think I will have to bring you back. Absolutely. Um, okay. Arley, if anybody wants to connect with you, where can they find you? Yeah, they can find me on social media at dr dot arley dot nd and my website is Arley Millyard.

Do ca I practice virtually throughout Ontario and people can also come see me in person in Toronto at Young in St. Clair. So yeah, come say hi. I'm so friendly. Amazing. Thank you so much for taking the time to talk with me today. I feel like I learned so much and I feel like people listening will really love this content, so thank you.

Alright, hope so. Thank you all for taking the time to listen to this podcast episode. I hope you loved this conversation as much as I did, and if you did enjoy it and you have a second, please leave me a review. If you take a few seconds out of your day to leave a rating, leave a comment. It makes such a big difference to getting this podcast out there, and I really appreciate it.

And if you're looking to work with Dr. Arley Millyard, I will link all of her information in the show notes below. I hope you all enjoy the rest of your day, and if you get a chance. Step outside. Sit down, find your sit spot, and have a glass of water and hydrate, because I know that's exactly what I'm going to go to.

Alright, until next time.