212: If You Struggle To Keep Momentum For Your Skin, Here's Why w/ Michelle Nilan, CNS

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Mindset is an important, albeit overlooked, piece of the skin health puzzle. How you feel about your skin condition can have a huge impact on your skin health journey!

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My guest today is my colleague, Michelle Nilan, CNS. Michelle is a clinical nutritionist, yoga teacher, and ACSM-certified personal trainer. She is the associate clinical nutritionist in my private practice and has been working with me since June 2020!

She has a master's in human nutrition from the University of Bridgeport and a bachelor's in philosophy from Humboldt State University.

Through her work with me, Michelle has developed an extensive understanding of the complex relationship between the skin, gut, and overall health, and values being able to turn this into practical, actionable guidance to help others become well. She is additionally well-versed in metabolic conditions, insulin resistance and diabetes, and nutrition for high-risk pregnancies.

Michelle also has a history of her own skin struggles with severe cystic acne, fungal acne, and tinea versicolor, as well as with managing thyroid, hormone, and autoimmunity issues, and knows all too well what it feels like to have significant life-impacting symptoms completely dismissed and be told by doctors that she’d “just have to live with it.”

She is grateful for the opportunity to help others avoid the years of suffering she had to endure while trying to find and address the root causes on her own. Due to her work in philosophy, as well as her personal history of childhood trauma, she has a deep appreciation for the invisible mental and emotional suffering of skin and health issues that aren't obvious from the outside, and allows this to guide her approach of seeing a whole person rather than merely a collection of symptoms or a problem to fix.

When she’s not working with clients, Michelle enjoys staying updated with the latest nutrition research, lifting weights, reading, going to museums, spending time in nature, drinking coffee while people-watching, and playing with her cat Daoshi.

Join us for Michelle's first-ever podcast interview as we discuss why you could be struggling to maintain momentum with your skin.

Have you lost momentum in healing your skin rash? Tell me about it in the comments!

In this episode:

  • The three different types of mindsets when it comes to viewing your skin issues
  • Self-sabotage + why this is a problem many of us struggle with
  • Clues that you're possibly in a self-sabotaging behavior pattern
  • Realizing the value of self-compassion
  • How to begin accepting where you are + taking consistent action


“There are really three main ways that you can see your skin issues, and those are engulfment, rejection and acceptance.” [1:43]

“Depression a lot of times does come along with skin issues and there can be a learned helplessness because all of these protocols haven't worked, you've done this medication and that medication and this diet and read that book. But that's really a learned behavior, which means that you can learn to come out of that.” [2:02]

212: If You Struggle To Keep Momentum For Your Skin, Here's Why w/ Michelle Nilan, CNS FULL TRANSCRIPT

Jennifer: I am so excited to have my colleague here, Michelle. Michelle, thank you so much for joining me today.

Michelle: Thanks so much for having me, Jen. I'm really excited to be here and grateful to be here.

Jennifer: Yeah. So I know that this is more your area of expertise, more so than mine, especially given your background, and that's why I thought you'd be the perfect person to talk about this because I feel like it can be really difficult from the mindset perspective of how we approach and deal with the journey forward. Right? It's not always easy. It's not just like you can muscle through it. Some people can't just muscle through it. Some people can. But I do think that your mindset really matters. I do want to preface that the conversation we're going to have today is not about whether or not you can or cannot financially afford to do some sort of integrative type approach or holistic or functional approach, because we recognize that everybody's in a different position financially.

Jennifer: We're also not talking about physical states today that may prevent you from taking actions. So it's really not about that. It's about how you're approaching the … and where you are essentially from a mindset perspective. So let's talk a little bit about the three different types of mindsets or the ways that people view their particular skin issues. Can you tell us a little bit about them?

Michelle: Yeah, absolutely. So this is definitely not a physical state. This is where your head is at. There are really three main ways that you can see your skin issues, and those are engulfment, rejection and acceptance. Just to kind of give a brief overview of each one, in engulfment, this is all about how much your skin issues are part of your identity. In engulfment, they really dominate your identity where you define yourself in terms of your skin condition. Whatever's going on with you, that's your primary focus in your life, pretty much to the exclusivity of everything else. With engulfment, there's a pretty high risk of self-sabotage because it's a core part of your identity and letting go of that is it's a painful thing and it's a hard thing. Even if you hate your skin condition, even if all you want is for it to be gone, if it defines you, letting go of that is letting go of the core part of who you are. So that really requires a full grieving process. Again, even if you hate it and don't want to be anywhere near the situation that you're in.

Michelle: So the second one is kind of the mirror image of engulfment, and its rejection. Rather than how much your skin dominates your identity, that's how much you reject your skin entirely as part of your identity. It's almost like seeing it as a threat or just unacceptable to your being, and so you deny whatever's going on with your skin, either by ignoring it outright or refusing to get any appropriate treatment for it or take any action toward it. It's kind of like, “Oh, whatever. It doesn't bother me.” It doesn't matter what state your skin is in. “I don't care. It's not a problem. Whatever.” This also can apply to gut issues. Like, “I have diarrhea every day and I don't care. It doesn't bother me.”

Jennifer: It's normal.

Michelle: Yeah, “I'm always bloated, but it's fine.” A lot of times this is a coping strategy because engulfment and the skin condition can be really painful, not just physically, but emotionally and mentally and rejection also can lead to the same self-sabotage behaviors by just straight out not doing anything about it. So the third one is … basically it's the healthy one. I also want to say none of these conditions are static. This is not a permanent state. Whatever one you're in, and you can be in different degrees at different times, but you're not stuck wherever you are. I'll get to how to get unstuck, how to figure out where you are a little bit later, and so what we're really trying to move to is acceptance, which is a third state, and that's a lot more adaptive and that's how much you accept your skin as part of your identity, rather than the dominant component of it or just outright ignoring it.

Michelle: Where other parts of you do come first and your skin is less central to who you are and what you do and how you interact with the world, but you can still manage it and treat it and do a protocol, whatever you have to do, without being completely overwhelmed and overtaken by it. It allows you to live a life much more normally then if your mind is just constantly on your skin, on your skin, where you can't focus on anything else, and this is the least likely mental state of self-sabotage.

Jennifer: With any of these, for somebody who's to a point of near hopelessness, like they just pretty much assume nothing will work, how would you characterize someone at that point in their journey where they're just like, “Well, I assume failure. I assume nothing's going to work. I don't feel like I have any hope anymore.” Would they kind of oscillate in-between engulfment and rejection, almost rejecting that there's even the possibility that they could get better?

Michelle: Absolutely. Hopelessness is not exclusive to any particular mental state. Both engulfment because it's so overwhelming, and maybe you've tried so many things that it's hard to have such a public-facing thing that also impacts a lot of times your actual activities in your life, your ability to engage with what you love. So depression a lot of times does come along with skin issues and there can be a learned helplessness because all of these protocols haven't worked, you've done this medication and that medication and this diet and read that book. But that's really a learned behavior, which means that you can learn to come out of that.

Jennifer: Oh, that's interesting. So the hopelessness that you feel and the actions that are the result of it are learned. It's a learned response, essentially.

Michelle: Yeah. Just based on prior experience, because that's really all that we can base our perspective on, is our previous experiences. To that end, I also want to say that you're not bad if you're in engulfment or in rejection. It doesn't make you a bad person. There's nothing wrong with you. In fact, both are completely normal responses to the difficulty and to the experiences of maybe unsuccessful attempts previously. If you worked with a practitioner or multiple practitioners that maybe didn't really know about certain skin issues and their protocol didn't work, or they seemed really lost, that lack of faith can also then applied to everything else, just like a blanket. Again, because you can only ask from your personal experience, which is so far nothing works. You still have your skin issue.

Jennifer: Yeah. It's also hard too when there's no immediate success, which is very common because, well, when we go from the conventional route, which I described as the super highway to symptom suppression, a lot of times, and listen, there's no judgment around that. For some people, that's what they need to do in order to be functional. They got kids, they got a life, they got a job. I understand. But when you start to go and dig into the root causes, there is no immediate gratification. Things take time, things take more than one protocol or more than one shift. If you don't see something quickly, like you're used to, you've been trained essentially through the medication model of you take a pill, you feel better tomorrow, or you take a pill and maybe at least in five days, you're going to feel better, that's not always the case with this type of approach.

Jennifer: That can be really hard. It can be really, really difficult for someone to say, “Wait, how long is this going to last? I don't know if I have that fortitude within me to keep doing this.” That's why I also believe it's so important to paint the picture and be clear about how long the journey is ahead, because it's very difficult when you're like, “I want it now,” but now isn't … that's not realistic. That's not …

Michelle: Right, and skin takes a long time to heal. It's slow, especially if there are simultaneous things going on. If you're in TSW, if you have an autoimmune disease, some other kind of health concerns, or even just a ton of life stress, that also will impact your immune system and your ability to heal. It's also not linear. It may be, improving, improving, and then suddenly you get this dip and that's part of the journey. That also unfortunately makes it much easier to feel like giving up. When you're in engulfment, you're just so involved in your skin condition. It's such a part of you and you're always focused on it. So you want that immediate gratification. You want it to be gone. Then the opposite in rejection, you want the immediate gratification so badly that the most immediate way is just by ignoring it, then it's gone.

Jennifer: This also plays into how people can self sabotage their journey as well, because sometimes we get in our own way. It happens to all of us. I know I have certainly sabotaged my own journeys and I've shared about different things and mistakes that I've made in the past. I do think this is, again, a part where mindset is really important. So with these two, engulfment and rejection, how do they play into the whole self-sabotage piece?

Michelle: So in engulfment because you are at the skin condition, like I mentioned earlier, it's the core part of your identity and to no longer have a skin condition means to no longer have an identity. That is terrifying. Because you've already envisioned a life where you always have your skin issue, you are your skin issue, and you always have to manage and maintain it. You've arranged a life around it, where you interact with the world as this skin condition. It's almost like you maybe not forget the other parts of yourself, but you put them aside. You put them on the back burner because this is primary. Then, again, mirror image in rejection. If you stop rejecting your skin issue and say, “Okay, yes, this actually is a problem. This does bother me,” you're saying, “I was wrong. A core way I interacted with the world was wrong.” So you're also getting rid of a part of your identity and that's that same pain, but just on the kind of opposite end of what it looks like in engulfment.

Jennifer: The one thing that was interesting as you were talking about the engulfment that I was thinking of too is that a lot of times you'll see folks who really struggle because they have a community, right? The community that really understands them. Then unfortunately, when they get better, they don't feel as connected to that community anymore and they start to realize that the social life that they used to have has moved on in the process. A lot of their friends and family who didn't understand, they don't have relationships with anymore, and now this other community they were so rooted in, they're not really there anymore and they don't necessarily want to still be stuck in … Some people do, but a lot of people don't. They want to move on with things, but they do find that they don't have the confidence that they thought that they would have.

Jennifer: It's like they're still stuck with this identity, essentially, that they obtained and cultivated unfortunately, while in this very painful at times, very painful, embarrassing state essentially. I've noticed a lot of people struggle with confidence, even after rashes can go away because there's a lot of inner work that still needs to be done of embracing who they are and learning who they are. So for someone who is struggling with self-sabotage, what are some red flags that they could easily identify right now that … and again, this isn't about judging yourself. It's not about saying you're bad or you're doing a bad job or you're failing or any of the things that we tend to say about us, but what could someone start to tune into or pick up on that could be a helpful clue that they're possibly in a sort of self-sabotaging behavior pattern?

Michelle: So there are a few red flags, and it's really important to be honest with yourself about this, and also just be willing to see am I on a path where I'm going to self-sabotage. One of the biggest things is using phrasing that starts with I am. Like, “I am sick. I am anxious,” which identifies you as the condition, instead of just presenting with it in the present moment. In skin conditions, it is a little bit more tricky to identify because the accepted phrase is, “I have eczema,” or, “I have psoriasis,” rather than, “I am eczema.” So that's where that honesty comes into play, and open-mindedness, where you have to explore for yourself whether what you're actually saying is, “I am eczema,” or, “I have eczema,” at this moment.

Jennifer: I also will share too and I am guilty of saying … I'll say, “My eczema,” which means I have ownership of this thing, but I don't physically … I mean, see, I even said it. My eczema. I was going to just start that off. My eczema is in remission, but it's like for so long, I identified, it became a part of who I was trying to get rid of it. I did probably some degree take ownership of it and that's how I talk about it. I recognize that it's not probably the best way to have a descriptive relationship with that skin condition that I formerly struggled with, but I even do it.

Michelle: Yeah. I had very severe cystic acne at one point and I noticed that I kind of switched as I went through my own journey. I switched from saying, “My acne,” to, “The acne.” If that phrasing feels comfortable, then try it out. Instead of saying, “My eczema,” “The eczema.” “The eczema is really itchy today,” and that can help you even just train your mind, get out of that helplessness. It's not yours.

Jennifer: I've got some work to do, Michelle. I've got some work to do. [crosstalk 00:18:22]. I'm admitting it. I'm admitting it for everyone to hear. So you don't want to feel like you're alone on this. I have work to do still too. What else in terms of self-sabotage? If we're dealing with … you were given directions to follow, you're working with a practitioner or you really decided to commit to doing some sort of … you picked up a book, you bought a book that lays out a plan for you. Where do you tend to see self-sabotage show up for people in those particular situations?

Michelle: Yeah. So the one I just covered is really the main pre-action step one. There are several that become visible when you start to try and take action, which is where the core of everything is. It's in the action. The first, whether it's a book or a practitioner or what have you, it's failing to thoroughly read through and follow the protocol. That's step one, to read carefully and do as you read. Then from there, let's say you read it through carefully. Picking and choosing what to follow and then expecting the outcome that is basically presented as going to occur without doing the exact protocol as it's laid out.

Michelle: If you're working with a practitioner that's expecting the same quality, whatever you have an expectation of, without discussing your changes that they've made. Presumably, this is a knowledgeable person and they did certain steps on purpose. Hopefully. That's the hope. So not doing that, or even just consistently forgetting to take supplements or an action that you've agreed with them to do. Avoiding communication with them because you don't want to bother them. That's their job. That's what they're doing, is helping you. By not asking for help, by avoiding communication, you're not allowing them to help you. You're saying, “No, you will not help me.” You may not be saying that verbally, but that's what the action is saying.

Jennifer: I'll also add to this too, that in terms of … when I'm working with a client, if they truly believe, if they look at, say, a protocol I custom built for someone, and you've seen this happen where someone will say, “Look, I'm a little confused. Why are we doing this?” Or, “I don't feel comfortable with this. Could we try something else?” I'm completely fine with someone expressing their concern because it takes two to tango here. A, it's not my body and B, it's also not my journey. I'm here to be a copilot, as I've said repeatedly. So I think it's important to have discussions when you are confused or you have questions or concerns about specific things. But what we're really talking about is where you disengage from that conversation and you just go, “You know what? I'm just not going to do that.”

Jennifer: Then what inevitably happens is six, eight weeks down the road, I sit down with that person and I'm like, “Okay. So how's everything going?” For someone who say, for example, just stopped taking magnesium citrate because they have chronic constipation and their constipation has gotten way worse and they're unhappy with their progress and all these things are going wrong, and I'm like, “But you stopped doing these things. Why didn't you ask? Why didn't you express that you were having a problem? Why didn't you let me know? I would have worked with you. I would have explained. I'm happy to do that,” and they just didn't want to bother me. They felt that those pieces, for whatever reason, weren't important, even though they were really important.

Jennifer: So now we've lost time as a result. So that's why communication is so, so important. I just want to underscore that it is crucial to have an open line of communication and if you're confused or concerned, it's okay. You're not undermining or self-sabotaging yourself by having those conversations. But by avoiding them, you can lose time because you're making a choice that might not be the best for yourself because you just simply don't have that knowledge and that wisdom to be able to apply to that particular situation.

Michelle: 100%, I agree with you. What would I need as a clinician is for you to tell me what you need from me.

Jennifer: Exactly.

Michelle: That's the whole thing. Otherwise, I can't help. I don't know what's going on. If you're not honest and if you're not willing to be open about it, then it's impossible to help. It just makes it impossible.

Jennifer: Yeah. It makes it very difficult. So for somebody who is essentially … They're like, “Oh, oops, I got to raise my hand here. I think I'm doing a little bit of self-sabotage,” how do they start to overcome this and shift more into that acceptance state of … By the way, I would just want to clarify. Acceptance doesn't mean that you just accept that you have skin rashes and that this is just the way you are and you just embrace it. That's not what acceptance means. We're just getting into that mindset where you're like, “All right, I know what I need to do. I can put one foot in front of the other. I'm going to follow directions. I'm going to work collaboratively.” My goodness, that word is a mouthful. How do we start to shift into this state of acceptance?

Michelle: There are quite a few ways, and it really just starts with realizing you're more than your physical body. That's where acceptance is not just, “Okay, I have this, I guess I'm living with this forever.” It's accepting it as a condition that you have, as an occurrence in and on your body, but that there's so much more to you besides that. You're whoever you are to your family, you're whoever you are to your community, to maybe your workplace, even to your pet, to the world, you play other roles in the world besides person with skin problem. Also, beyond that awareness of how you're approaching your own skin condition, and also how you've trained others to speak about your skin. For example, if you have always been telling your family, “Oh, I can't do this because of my skin. I can't do that. I'm not going to this party and that party,” they're going to start talking to you as if you can't do those things.

Michelle: It's understandable that that happened. You're not bad for kind of allowing for that environment, but awareness of it is what will kind of allow you to then … Hopefully if you have the willingness to say, “Hey, you know what? I'm going to come out of this role.” Even to have an honest conversation about it. Like, “Hey, I'm going to try this, or, “Hey, can you try and make my skin less central to how you interact with me?” Then another one that's … this one can be very difficult, but it's to be very rigorously honest with yourself about whether some part of you is holding on to, or even to some extent enjoying that patient role. Are you getting something from this that you're not getting somewhere else? Are you maybe being taken care of, even if it's by doctors or dermatologists? Are you getting your attention that maybe you wouldn't get otherwise?

Michelle: Again, that can be really, really painful. So also be compassionate with yourself as you're going through this process. You won't do it perfectly every time. You might feel like, okay, today in this moment, I'm in acceptance. An hour later or tomorrow, you're engulfed again, or you're rejecting it again. That's fine. Whatever state you're in is not permanent, even acceptance. You have to keep working on that as well. Something really, really important. Once you've gotten awareness of what's going on inside of yourself, if at all possible, express this. Express these feelings to a trusted person that you know, that you don't doubt even a little bit this person will not shame judge or dismiss you. You may not have a close friend or a family member who fits that role. So this could be a therapist, or it could just be journaling about it because the pen and paper, it won't judge you. It won't dismiss you. It won't shame you. It'll just listen.

Jennifer: It can also bear the weight of the things that you feel are so heavy. Maybe you feel they're too heavy to burden on someone whom you love, or they're maybe not the right person to have a conversation with, but it can be incredibly empowering to write something down and start to create some distance between yourself and it. Because it's no longer in you. It's out on the piece of paper, which can be very therapeutic. I was also going to say too, getting back into doing something that you enjoy. Like many of us, I loved working out and when I started having eczema, I had to stop going to the gym. I had to stop working out. It's not even being bothered. It was too painful to hold weights because they were rough on the inside where the handles were so it would tear up my skin. Then also I couldn't wash my hands afterwards because the water hurts so much.

Jennifer: So I started to develop this aversion to exercising and so it had taken me a really long time to begin getting back in the routine of exercising. But for somebody who feels like they really had to give up a lot, what do you suggest that they do in terms of getting back, moving … We'll say moving into the direction of the things that they used to love doing.

Michelle: So if you know the thing that you can't do right now that you love doing, the thing that brings you joy, find a small way to get in touch with that. For example, if you relaxed at the end of the day with long hot baths, but you can't, you can barely shower anymore, not to mention getting a hot bath, the smallest version of that, drink some hot tea. Feel the warmth, just come back to being in your body. Or if you can't go to the gym, do gentle stretching at home. You're not looking for the same thing. You're looking for the essence of what it gave to you and a way to show kindness to your body of, “Yes, I love you and I accept you. I'm going to do this good thing for you because I'm more than whatever pain this is causing me.”

Michelle: Even meditation, progressive muscle relaxation. Meditation doesn't involve rubbing against anything or touching anything. You can just lay there and just breathe, and that's really underestimated. It's taking the small steps that make the bigger steps seem easier because when you get there, they're still small steps.

Jennifer: Yeah, and they're so, so crucially important as you slowly begin to reclaim that sense of normalcy and your life back from what you feel like you really lost. It's so, so important to start doing things again that you really love, that bring you joy, even if it's just the smallest littlest thing that you can do, and you savor that and slowly with time, you should be able to do more and more and more, especially as your skin and your health and whatever else is going on improve. Michelle, I just want to thank you so much for sharing all of these tips and these strategies. I think it's important to look at mindset because mindset is such a huge piece of whether you stay the course or you're just the type, you're a quick start, you're like, “Oh yeah, I like the idea, ” and then you throw in the towel because she didn't really feel like following direction. You didn't like showing up for the calls. You didn't like doing the random things.

Jennifer: This might help explain to someone why they are struggling with this, to really put one foot in front of the other, or they're feeling a sense of hopelessness and better understanding where that might be coming from. Just to remind everyone as well, Michelle works in my practice. She's one of my associate clinical nutritionists. So some of you who are listening have spoken with Michelle before, and she's got a lot of great knowledge and wisdom and experience. She's dealt with skin issues herself and a lot of different health issues, so she has a ton of empathy, but we figured this would be a great conversation to have because a lot of people can identify with this issue. But Michelle, I just want to thank you so much for joining us today and sharing all of this. I'm sure we're going to have more on maybe this and other topics that we see in the practice at a future date, but thank you so much.

Michelle: Yes, absolutely. Thanks so much, Jen. I'm really grateful to be here and I just want to end with practice compassion and kindness for yourself. This is human. Whatever's happening, whatever state you're in, it's completely human and it's totally normal and probably going to happen where you fall back into the old habits, old patterns. And you know what? If you don't know how to practice compassion, ask us. Ask me, ask Jen, ask your practitioner. How do I become more kind to myself? How do I practice compassion? It's just that honesty, an open mind and the willingness to try. That's all you need. You need willingness and that's just what it comes down to. I'm really grateful to be here and grateful and happy to help any way I can.

Jennifer: Awesome.

“There are really three main ways that you can see your skin issues, and those are engulfment, rejection and acceptance.”

Jennifer Fugo, MS, CNS

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.

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