[DR. CRISTINA CASTAGNINI] Behind The Bite podcast is part of a network of podcasts that are good for the world. Check out podcasts like the Full of Shift podcast, After the First Marriage podcast and Eating Recovery Academy over at practiceofthepractice.com/network. Welcome to Behind The Bite podcast. This podcast is about the real-life struggles women face with food, body image and weight. We're here to help you inspire and create better healthier lives. Welcome. Well, hello everyone. Welcome back to the show. Today I really appreciate the guest we're going to have on. She is here to really tackle some of the hard questions people have about recovery. I know that anyone listening out there who's thinking about going into treatment or maybe who is in recovery, has some difficult questions they want to ask themselves or maybe have some fears that maybe are keeping them from either going into recovery treatment or staying in recovery. Certainly, as someone who went through that journey myself, I know that there were some really difficult times and fears and questions I had myself. Now as someone who's helping people through that journey, I do hear the questions and the fears, and I know that some of the main ones that we're going to discuss today on the show are ones that people listening probably have themselves. With that I just want to delve in and get into the show with our guest. You're in for a treat for anybody who's listening because our guest is an expert. Emily Murray is a licensed registered dietitian nutritionist and certified eating disorder specialist through the International Association of Eating Disorders Professionals. She established her private practice Murray Nutrition in 2020 where she and her two associates provide nutrition counseling and coaching. They provide that to individuals who suffer from eating disorders and disordered eating, weight and body image concerns and co-occurring mental health concerns. Emily is often helping her clients sift through food and feelings and invites the deep emotional work that is required to heal from disordered eating and eating disorders. In her free time, Emily enjoys arts and crafts, writing and journaling, being outside and spending time with her husband. Well, Emily, welcome to the show. [EMILY MURRAY] Hi. Thank you so much for having me. [DR. CRISTINA] Well, I'm excited, like I said in the intro. Curious that you have a lot of listeners, they're always curious like, how did the people you get on this show get into the field? So I'm wondering, would you mind sharing a little bit about that with us? [EMILY MURRAY] Okay, so my name is Emily Murray. I'm a registered dietician in Nashville, Tennessee. I'm a certified eating disorder specialist. How I got into the field, so I actually went into nutrition because I had IBS, so I was diagnosed with IBS in high school, and that was pretty distressing to me. So I thought, okay, I'm going to go into nutrition and heal my gut and it's all going to be great. Through that process, I actually ended up developing my own eating disorder. I went through, I did treatment, I worked with a registered dietician and a therapist and medical doctor, and it was a really, really great team. I had an awesome experience. I would say that that really saved me from being, a dietician that was going to mislead people. When I went in to become a dietician, I got caught up in all the clean eating and orthorexia type of stuff, which is yes, just an unhealthy obsession with clean eating and food morality. I thought that that was going to be the way to heal myself and how everyone should eat. I had very little awareness of how mental health impacts your GI system and they got brain connection and all of that stuff. Long story short, I had my own history with an eating disorder that was a really awesome and healing experience. So I knew that that's what I wanted to go into when I was feeling better and ready to do that. [DR. CRISTINA] Well, thanks for sharing that. You said that, I don't know too many people that actually say that, like going through your eating disorders. This is an awesome experience, healing for sure. But I'm wondering, would you be okay sharing a little bit more about that? Because I think most people think about going through eating disorder treatment as this really long, lengthy, painful process that doesn't actually end up in healing. So it sounds like for you that was quite different. [EMILY] Yes, yes. I will say, as we know there are a lot of different factors that can impact recovery outcomes and things like that. I think one for me is that I had relatively early intervention. So I had been struggling for about a year and a half or two years with my eating disorder before I got help. That was a bummer. I needed help asap. However, a lot of people wait a lot longer. They don't have the resources, they don't have access, we don't know what's going on. So I think that that was something that the impact in my own journey as well as having the resources to access care. I think it's easy looking back on it now and being like, yes, my team was awesome. It was a great experience, but and that's true. But in all reality, I mean, it was painful. It was horrible. There were days when I thought, why am I doing this? I'm never going to get better. This feels so painful, this isn't worth it, my team's crazy, I don't trust anyone, I feel so alone. So it was definitely really, really hard. My eating disorder really picked up in college. College was really hard for me. It was a hard transition time. I didn't have a lot of friends. I felt really anxious had, a lot of mental health stuff going on, and that really just created the perfect storm where my hobbies ended up being exercise and restriction. I had the underlying IBS stuff so it really compounded yes, it really compounded, but I got to a point where I just felt miserable mentally, emotionally, physically. I remember calling my mom one day and being like, "I think I have an eating disorder. This is not good. I need to get help." I was ready. I was beyond ready. I think that was helpful too, versus just being like a teenager being brought to treatment by a parent. That's just, it's a different experience. Yes, that's a little bit more. Do you have any, are any questions coming to mind about that? [DR. CRISTINA] Well, as I'm thinking about that too, a lot of people like yourself have complications on top of the eating disorder, like IBS or diabetes or medical conditions that I can, I'm wondering for you working now in the field, do you think that it's harder to treat if there's maybe medical diagnoses like IBS or something else where people are looking to have somebody like yourself, a dietician, a nutritionist, give them these guidelines and say what foods can I eat? Because I often hear people say, well, my medical doctor told me I can't eat this anymore. I can't eat these foods anymore. So they're looking, I guess for guidance or they've restricted themselves so much like you said you had restrictions and things, and I don't know if it was from IBS or something else to start, but a lot of people start out with restrictions because of medical diagnoses. I don't know if that's a path for a lot of people that you've seen or [EMILY] Absolutely, absolutely. I mean, I think it is harder to treat. It's just another layer. It's just another layer to the nutrition rehabilitation process, so establishing very normalized eating patterns. There's just other considerations to factor in when someone has, for example, something like Type 1 Diabetes, and it might be important for them to have the carb count to put in for their insulin. Or if someone has IBS or Crohn's or Ulcerative Colitis or something of that nature that can make eating really painful at times or really, really tricky or there might be certain restrictions. So that is, it is more complex in terms of, there's just another layer to peel back and something else to consider versus someone, eating disorders are super complex but if someone doesn't have that, the biological illness, chronic illness that it does add another layer, it makes it tricky. [DR. CRISTINA] The word restriction has come up a couple times as we've been talking. I know people that are listening probably can relate or maybe they're even restricting right now for all sorts of reasons, whether it is they feel like they have to for their medical illnesses or in the throws of an eating disorder. That gets really dicey when it comes to treatment because I know that's the biggest fear, at least, I don't know about you, but I get lots of people making comments, like, that's my biggest fear in going into treatment is then I have to eat and what's that going to do to my body? People oftentimes will start treatment and they're not restricting anymore, and then they bounce out of treatment because that's so scary, like no longer restricting is the scariest part. I'm wondering, I don't know if you're willing to share your experience with that or what you see now with people in terms of how they manage no longer restricting in that part of treatment? [EMILY] Oh my gosh, I mean, it's scary for so many reasons. I think number one being, even subconsciously, I think a lot of people don't realize this until they enter treatment, but restriction numbs us emotionally. So there's this benefit that we may not even really see where some of our emotions, anxiety, depression, some of the really hard things that we experience in life. Restriction when our body doesn't have enough calories, it's not on line enough to process all of that stuff and to worry about it. So I think it's very common when we stop restricting, all of a sudden we start feeling all these things. It's like when we push a beach ball down underwater, we can keep it there for five seconds, maybe 10 seconds if you're really good, but it's going to come up and it's going to come up hard and fast. That's what happens a lot of times when we stop restricting, we feel worse before we feel better, because we feel all these things that we shut down physically. We feel worse too because the body just has to get used to having a normal amount of food in it. If you've been restricting and then you start adding foods back in, that might be really uncomfortable for GI system. You might get full easily, you might experience nausea or alternating stool like constipation, diarrhea. You might have a loss of appetite. So there's the emotional piece, there's the physiological piece and then there's a weight gain piece too. If you are restricting your food whether or not you think you need to restore weight or not, your weight is probably being artificially suppressed. So when you add back in food, it's not uncommon to gain weight, not because foods are, those foods are bad, not because those foods are weight gaining causing foods, but because you've been depriving yourself. So, of course, when you start having the appropriate amounts, you probably will gain weight. But that is very distressing for a lot of people because of the culture that we live in where fat is bad, weight gain is bad, incredibly narrow than ideal, it is just, it's painful and it's really scary. [DR. CRISTINA] Yes, that's, it's always a hard topic to broach because when people, I don't know, you get up, people I work with ask like, "Well, what's going to happen when I go into treatment?" But I'll go into treatment as long as I don't gain weight. To your point of like the society we live in, really putting all this fear into that how do you have conversations with people about their fears and when that comes up? [EMILY] Yes. I mean, it's really, really tough. Something I never want to do is guarantee that someone will not gain weight or that they will stop at a certain point because that's just not, I don't have the power to know that. What I can do is provide education on the fact that body diversity is a very real thing and we are all genetically created very differently and it's very common for there to be a wide variety of bodies on this earth. Two of the same people could eat the same food, work out the same amount, whatever, move their body the same way and they would look very different. So really just providing education and normalizing all types of bodies, I think is important. I think also normalizing the fear, like it makes sense that there's fear there, but we also have to think about what the eating disorder and the restriction is taking away. Because yes, most people in eating disorder treatment, they're not going to be like, yep, sign me up for the weight gain. I'm super happy about that. That would be pretty uncommon. But some people are at the point where they're like, I'm miserable. I may not like the weight gain. I may not love it, but yes, I can't keep doing this. This is getting in the way of my family life. This is getting in the way of my social life. This is really hard to make friends this way. So I think when we can think about what the benefits could be of restoring our nutritional health and yes, that could mean some weight gain, but it could also mean a much freer, brighter, fuller life. I think it's important to think about some of those things. [DR. CRISTINA] I love that too because I think there's way too much emphasis and focus on the external, the body and it's really the eating disorder because you're thinking I'll be happy when, or it's all about that. That seems to be so much of like the deterrent to entering treatment and that's really just a big distractor. Like you said, it's not about that at all. It's really, like you said, looking at what is the eating disorder, like you said, taking away from your life. Because you could, what is the purpose if you're sitting at home, restricting alone, exercising all the time, and you "look great," but you're not socializing or you're not having a life? Why are you doing all this? You're just living this life on a hamster wheel and taking a step back, going like, okay, I'm doing all this so I can look good, so I can be happy but the path to happiness is really lonely and painful. [EMILY] Yes, yes. I think a lot of us believe the lie that the path to happiness is by being thin. [DR. CRISTINA] Right. [EMILY] Maybe we've experienced that. Maybe we have experienced compliments on our bodies. Maybe we have had weight loss or our current weight or whatever. Maybe that's been reinforced by other people. That's a fear a lot of my clients have of what are other people going to think? What are they going to think about me when I've gained weight? What are they going to think about me? They're obviously going to stop commenting on my body and blah, blah, blah, blah, blah. That's really painful. It is so, so painful. I remember crying myself to sleep one night just realizing how painful that is that some of the people in my life had no idea how to connect with me other than just saying you look great. Your weight looks great. This is the smallest I've ever seen you. That's so painful. That's so, so, so painful. What I try to encourage my clients to think about though is we're all living in this diet weight obsessed culture. So a lot of times when people haven't done their own work around this, they're just spewing out their stuff. They can't help it. It's the first thing that's coming out. They don't know how to say, they don't know how to talk about hard stuff. They don't know how to say, "Hey, how are you really doing," and just go straight to, "Oh, you look great, blah blah." The other piece is that some people might judge you, some people might say rude things to you, I don't know. But a part of recovery is figuring out who are my people? How can I find connection in this world that's apart from just this superficial body thing, like also my clients, like compliments that's not the same as a connection with someone. The eating disorder really is just a master of disconnection and isolation. I think just thinking about that, as we're thinking about the possibility of weight gain, also what we talked about, thinking about the detriments or the really harmful things that could happen if we stay where we're at. [DR. CRISTINA] That's not a discussion very often had either. I think our society is very much pro-restriction as well. Like I look online sometimes and I'm shocked at what misinformation is out there about food. To your point about like you said, you went down the path a little bit there about clean eating orthorexia. I think that is very promoted and even I get, the majority of the people I get initial intakes really do think that what they read on the internet is true and accurate and I'm not going to say numbers here, but the low amount of fuel that they believe they need and that is required to sustain life is shocking to me. But that is rampant on the internet that's rampant out there as if it's like the common standard and it's way below what's actually necessary and needed. I don't know if you're finding that too, but it's shocking and people are often shocked when they do go into treatment. They get a meal plan or we discuss what they actually need for a daily intake and they're like, "That's way too much. I can't do that. It's scary." [EMILY] Yes. I mean, gosh, there are certain apps that people have used and there are websites where it's like completely underestimating nutritional needs or it might even estimate it but there's user error. Like someone's like, "Oh, I don't really move my body at all," or, "I think I need to subtract XYZ number for whatever they give me." There can be user error and they can just be off and counting calories meticulously looking at labels like that can just be a lot, especially for someone who's brain and temperament might run a little bit anxious, might be a little bit all or nothing. Those types of people are very vulnerable to this nutrition misinformation or even taking information that might be helpful but turning it into an extreme, and that's something that I really spend a lot of time with my clients with is like asking, where's the context here? Where's the nuance? Where's the gray area? Is this always true or has this become a rigid rule that's creating this prison in your brain that that's really hard to break free from? [DR. CRISTINA] Yes. I would imagine it's hard for you to counteract a lot of the misinformation out there because there's so much of it. I don't know what questions you get again, but I constantly hear it. Well, of course there's bad food. Of course, there's food that's unhealthy. How can you say processed food is good for you or okay to eat and like all these things because what they're reading online is absolutely not, this is bad. This is not okay. It's like, again, these absolutes and when you're in throws that eating disorder, it's really hard to counteract those distortions. [EMILY] Yes. Sometimes I'll make up a scenario and ask, "Hey, what do you think is healthier, going after dinner to get ice cream with a new group of friends that's invited you or sitting alone in your room counting almonds for your dessert?" A lot of people will be able to see like, ugh, even though I might have a hard time seeing that ice cream can be healthy, the first one sounds more well-rounded. The first one sounds like a healthier life because I think sometimes, we get so focused on nutritional health and choosing all the right ingredients and blah, blah, blah but then we forget about physical health or we forget about emotional health, social health, all of the other mental health, all of the other realms that are neglected when we get single minded and solely focused on all these numbers or things like that. That's something that, we'll talk about something like that. Also just trying to look at food more neutrally, like, hey, I don't really care if you think it's bad or good. We don't even need to get into that, really and truly ice cream. Like, there's calcium, there's protein, there's some fat, there's some carb. It's pretty balanced. It's okay. Am I asking you to have ice cream for every meal for the rest of your life? No, that wouldn't be healthy, but it also wouldn't be healthy to have kale for every meal for the rest of your life either. So really just trying to find the middle ground in all of these extremes. That's what you see online. All of the nutrition information is, it's just so extreme. It's so like, this is the one way to do it, I promise. It leaves people feeling really anxious and disappointed. [DR. CRISTINA] I love that you brought that up, that health is more than just what you're eating and your activity level. There's all sorts of different ways that your life can be healthy and that eating disorder certainly takes away your social connections and all sorts of other things in your life that make life worth living for sure. So I'm glad you brought that up. Yes, I don't think people think about that also often when they're in the middle of it all. Like you said, it dampers when you're restricting anyway, it dampers your ability to think clearly or feel things. It brings up another question I have too is these "healthy foods." I don't like using healthy, unhealthy, good, bad. I think labels are awful but when you're in the eating disorder people have those labels and so they get a little scared I find too. Well, what happens if I'm exercising or eating the foods I used to label as good or fat or healthy? Does that mean I'm back in my eating disorder? Is it okay to eat those things? People get all sorts of confused, and especially if they come out of like a higher level of care that in the outpatient or something, they're like, what do I do now? I'm feeling lost. I'm feeling ungrounded. [EMILY] Yes, I mean, it's tricky because a part of, if you have a history of restrictive eating, a part of your process is going to be allowing yourself to have foods that you did not used to let yourself have. Sometimes you need to have those foods over and over and over again for repeated exposure. So maybe for a while you're not picking any salads at all. You're just picking, I don't know, the pizza or you're just picking the pasta dish or whatever. That's really good. We have to have the exposure because that's how we get over the fears and that's how the anxiety comes down. But when I'm working with clients, we're not trying to take anything away really. We're not trying to take away fruits and vegetables and protein and all of that stuff, but we're making room for more. So we're not just having vegetables. We're not just having whatever, lean meats, clean eating, whatever, whatever all these ideas are. We're creating a lot more space for a lot more variety. Yes, if you used to be someone who used to restrict by eating XYZ meal or food, it can feel really scary to eat that food again. You might even have an aversion. Like for me, I had a certain meal that I had a lot in my eating disorder. Then in my recovery process, I was like, I can't even look at those foods. I'm not even going to mess with that. Then I remember I would see people who would eat like a salad for lunch and I'm like, they're disordered. They're disordered. I can't believe they're doing that. They are disordered. The reality is that in recovery you can have a salad and it not be disordered. There are a lot of people who are eating a salad and it's disordered. We never really know. It all comes down to intention and working with your own body. If you're working with a team, that can be really helpful too. In honoring what you're craving, what your body feels good on while also not letting fear drive the bus, which is important. [DR. CRISTINA] That's the big thing, the fear. What typical fears do you hear people talking about when you're working with them? [EMILY] I think it's fear of somewhat of the traditional foods that diet culture labels is bad. Then it might be fear of accidentally not eating enough. If I'm doing well in recovery and so I don't want to mess anything up or fear of eating the food that I once had in my eating disorder, fear of eating the diet option or whatever, fear of getting off of a meal plan and getting messy with it because that can, you know, what if I relapse? What if I'm not doing well? So I think that the fears can morph. Then of course, with a lot of my clients, I'll see different things like fear of eating in front of people, fear of grocery shopping, fear of choking or vomiting on the food. There's a lot of different ways that fear can come up with food that we're trying to tackle through. I primarily use CBT, Cognitive Behavioral Therapy. We're making connections with our thoughts and our emotions and our behaviors and we're really challenging some of the distorted thinking patterns. Then also exposure and response prevention where we are encouraging ourselves and challenging ourselves to eat the fear food and not doing anything about it. We're not going to go compensate. We're not going to go look up all this information about it. We're not going to, whatever. We're just going to eat the fear food and let it be and watch our anxiety rise and fall. Over time that fear food becomes a lot easier. [DR. CRISTINA] I hear so often, I'm sure that too, like, oh, I can't have that. I don't trust myself around it or I'm not going to allow myself to have that in the house because in the past I've eaten all of it or so that fear of like, what if I'm alone with that food? Or what if I actually have it in the house? Then what? [EMILY] Yes, what if I actually enjoy it? What if I eat too much of it? What if I binge? I think that that's a big one. It's like all of these what ifs, I think even if something like that has happened in the past, I think we can remind ourselves like, this is not then. This is a new experience, a new situation, a new season of my life. I'm not necessarily trying to go back to where I was. I'm trying to create a whole new way of doing things, and that's going to take some trial and error. You know what, if you accidentally overeat or binge in the process of trying to nourish yourself, that's okay. It's messy. It is so messy. It makes sense as a response to restriction biologically our body seeks out the foods that we aren't getting enough of. It seeks out foods that are going to nourish us and satisfy us. When we put certain foods on a pedestal or we tell ourselves, no, I'm not allowed to have those ever, and then we break the rule, it's really common to say, "Well, screw it, I've already messed up," and then just go punish ourselves almost by eating XYZ amount. So there's a lot of layers and it can be really, really tricky. A lot of times I think clients will see that when their worst fear happens, they're actually okay and they're more resilient than they thought they were. That sometimes the fear, the worst part was the buildup to the fear, but actually facing the fear was not as bad as they thought. [DR. CRISTINA] Well, it's great that you're speaking about this because I think just having the dialogue is important. I don't think we talk about this enough or people are open about it, which is the whole point of, I think why I have the podcast is because I want to bring out the realities or maybe what people aren't vocalizing themselves to maybe the people around them or what they're really afraid of or what maybe the hurdles are for them in terms of seeking out treatment, like the sphere of like, ''Oh my gosh, if I seek out treatment, are they going to make me try it, make me "try to eat" these foods and am I going to be able to do this? What happens on the other side?" Just to know like, yes, these things happen, but this is part of recovery, it's part of getting past all of this. Got this straight line of like, oh, you come into treatment and everything flows perfectly down this linear line. [EMILY] No, no, I know, I know. If only, if only. The other thing I often hear too, sometimes is clients who maybe aren't sure if they meet criteria for an eating disorder or a client that lives in a larger body having imposter syndrome. Like, I'm afraid that you're not going to believe me or you're going to look at me and be like why is she here, that I'm alone here, that I'm not sick enough. So I think fortunately the field has come some way in terms of recognizing that eating disorders and disordered eating impacts all people of all shapes and sizes, races, ethnicity and sexual orientation and gender and all the things. But I think weight stigma is still alive and real and that can be, when someone's experience that it can be just hard. So I think just providing that safe space for people really validating their experience in all body sizes and encouraging regular nourishment regardless of your body size can be really, really healing for folks. [DR. CRISTINA] Oh, absolutely. So often it's, "Oh, you don't look like you have an eating disorder." Or people tell themselves that, I don't, oh, I can't have an eating disorder. Look at me. It's like, again, this focus on the external when it's like, this is an illness. This has nothing to do with the external. You can't look at somebody and know if they have an eating, eating disorder, which one they even have for that matter. [EMILY] Absolutely. [DR. CRISTINA] So for anyone listening out there, I think that's very common that, oh, I'm not sick enough or I really don't have one. It's really up to, I guess, seeking the help of a professional and getting an actual assessment to know if you have one. [EMILY] Yes, and really a professional that knows eating disorders, and is help at every size and all the things, because I, that was a part of my story. I'm like, oh my gosh, I don't restrict enough. I'm not "underweight," like, I'm fine. I'm literally fine. Then I actually went and saw a dietician and I said, I got to a different point and I said, "I think I may have an eating disorder. I restrict and binge." She's like, "No, no, no, no, you don't do that. You don't do that enough to have an eating disorder." I'm like, "Great." I was happy to hear that, but then the eating disorder grew. It grew and grew and grew until it's like, okay, here we go. What we know is that the earlier we can intervene, the better treatment outcomes are. So yes, if you have people in your area that can see you, telehealth, have that specialty, that can be really, really important. [DR. CRISTINA] Oh, absolutely. That's why I love too, that you're a certified eating disorder specialist. Love having experts on here because you know exactly what is going on. Because there are people definitely that say they work with eating disorders and so much, I don't think they're doing it on purpose, but there's a lot of misinformation or just messages that are more in line with what's on social media or out in the mainstream more focused. At least I find, just be mindful and aware for anyone listening. There's a lot of information out there for people that say they're pro-nutrition, pro-health, pro-whatever it is. It's really a diet in disguise. [EMILY] Yes, absolutely. Absolutely. [DR. CRISTINA] So with that, if you want to work with Emily because she is an expert in the field and absolutely wonderful in helping people, how can they find you, Emily? [EMILY] You can follow me on Instagram at Murray Nutrition, m u r r a y, and then our website is murraynutritionco.com. Those are easy ways to get connected. [DR. CRISTINA] Fantastic. Your Instagram is amazing, so yes. Anyone listening, go on over there after and go follow Emily. She's great. All right, any last final words before we end? [EMILY] Gosh, I don't think so. I'm just really, really grateful that you had me on that we could have really, really honest conversations about eating disorders and recovery and the process that is, it's just so hard for so many people, and I'm just really thankful and grateful to be able to offer a word of encouragement and hope. [DR. CRISTINA] That's really, that is what it's about, I think the hope if we can have more discussions and people can really know, hey if I have an eating disorder, I can get better, I can recover. I think that's a lot of it. So hearing it even from you, like you had one and you recovered and know with all of great, wonderful work you're doing. That's inspiring. Thank you. [EMILY] Yes, absolutely. Thank you for having me. [DR. CRISTINA] This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, accounting, clinical, or any other professional information. If you want a professional, you should find one.