Steve Martorano 
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The Behavioral Corner 
Hi, and welcome. I'm Steve Martorano, and this is the Behavioral Corner; you're invited to hang with us as we've discussed the ways we live today, the choices we make, the things we do, and how they affect our health and wellbeing. So you're on the corner, the Behavioral Corner. Please hang around a while.

Steve Martorano 
Hi, everybody, welcome to the Behavioral Corner to me again, Steve Martorano. We're hanging here on this little podcast that we'd like to say as the podcast about everything because that's what winds up affecting our behavioral health, everything. The podcast is made possible through our great, great partners Retreat Behavioral Health, you'll hear more about them a little bit later on. So let me bring you up to speed on what September has been all about here on the Corner. And that is its National Recovery Month. And it's really important to focus on the notion of recovery. Because as we know, I don't have to explain to you, life can deal you a pretty rotten hand when it comes to your mental or physical health and well-being. And that's difficult, in whatever context you want to talk about. But it's very important. And this is why September is set up to remind people that no matter what the situation may be, recovery happens. It happens across a broad range of problems from you know, very serious physical things, to substance abuse issues, and mental health issues. People get better. They do. It's very important to remind people of that. That's what we've been doing here on the corner in September. And that's we're going to do today in an interesting way because the first time I spoke to our guests, I was surprised to learn so many things I didn't know about something I thought I understood which was eating disorders. To that end, we welcome a great friend of the show she's been on a couple of times before this Dr. Rhona Epstein. Dr. Epstein is a Ph.D. in Clinical Psychology. And as a result of that, she treats a wide range of issues with a specialty in eating disorders and food addictions. So Hi, Dr. Epstein. Good to see you again on the Corner.

Dr. Rhona Epstein 
Steve, it's always good to be with you.

Steve Martorano 
You know, at the beginning there, I explained that what we do is focus on recovery, because it's a word that's thrown around a lot. I don't know that there is one thing that constitutes recovery. I think recovery is an individual process. It changes from people to people, we want to talk about the possibility of recovery with eating disorders, or food addictions, how that recovery might be achieved. And, most importantly, what would wind up looking like? So let's begin at the other end of this. What were some typical eating disorders that you deal with?

Dr. Rhona Epstein 
Well, I particularly specialize in overeating. And really, I mean, food addiction, is my focus. So and, you know, people have questions about whether food addiction is a real thing. But in my world, it is. So I work with people who have totally lost control who cannot stop eating. Usually, it's not broccoli and chicken that they're overeating. It's usually sugar and fast food, high fat, highly processed foods, and dollar junk stuff. And so in terms of eating disorders, of course, there's other ones like anorexia, bulimia, I also treat because that's also in the category of binge eating disorders. Another one that these can be overlapping and sometimes food addiction can be in the other eating disorders. So they're not always so Bulimia is not always a food addiction. Binge eating disorder is not always a food addiction. But I specifically work with food as a chemical dependency.

Steve Martorano 
Yeah, the first time we talked about this way back when I was struck by the phrase "food addiction," how is it possible to eat food? If so we need food, and you've explained it perfectly. But before we get to that, you just said something that's really amazing. You're right, it isn't people, people do not get in trouble eating broccoli, or healthy foods. Now I know sugar is the main component here, I guess with regard to addiction as well, but psychologically, what have you learned? What can you tell us about why people don't binge on broccoli? Well, I mean, why not? Some people like broccoli. I like broccoli. I also like donuts and I could see myself overdoing it on donuts much quicker than I can on broccoli. Is that just the sugar? Is there something psychological going on here?

Dr. Rhona Epstein 
Or something physical. I mean, there's it's a combination of things. No, I don't...you don't get a hit in your brain from broccoli. I mean, broccoli is nourishing our bodies. It's providing what we need for energy. And for our health and our well-being. And yes, it tastes good. And I think on some level, it will taste good, especially if you put some things on it that make it taste good. My broccoli tastes good. I put a little olive oil and garlic...

Steve Martorano 
Right. Of course.

Dr. Rhona Epstein 
...a little salt and pepper, you know, you gotta make it taste good. Right? On its own. I'm not sure if is that delicious. But yeah, steamed broccoli is alright. If you actually look at scientific brain studies, you can see that when you eat the doughnut, which is not just sugar... it's not just so sugar...sugar, and fat, and other things that are put together and just the right combination, so that your pleasure centers in your brain, the same place that gets hit, where heroin and alcohol and cocaine get hit, the same place in the brain is getting a hit. That's why we have experienced, like comfort or why we get an ecstatic sort of, you know, orgasmic, you know, we say like, "Oh, my gosh, this is orgasmic!" I have to have more, or I can't stop eating, because it has more of an effect on the pleasure centers in the brain.

Steve Martorano 
So chemistry is the answer. It's a distinguishing feature. No matter how much you like broccoli, it's going to be chocolates and doughnuts that get you.

Dr. Rhona Epstein 
And there are people by the way, in the eating disorders world who will binge on vegetables.

Steve Martorano 
Oh, really?

Dr. Rhona Epstein 
Yeah, I mean, that's more the anorexic, bulimarexia. Their obsession with wheat is so great, they wouldn't let themselves go for the donut.

Steve Martorano 
I see. The distinction there, I guess then is a psychological one. The two things are different. Someone addicted to food is operating on a different disorder level than someone who is bulimia or anorexia. You are among the first people I ever heard of who looked at food as an addiction on the addiction model.

Dr. Rhona Epstein 
You won't meet too many people. I mean, they're going it's getting bigger. I mean, they have big, quick sugar summits and kick sugar summits and doctors now, who are psychiatrists, and endocrinologists and big doctors who are out there who are really actually going even after the food industry, because they feel like they're making a sick with cardiovascular disease and diabetes. And I mean, people are really getting sick and obesity-related issues. And there's a serious problem that's related to sugar, lots of them. And so nowadays, people are starting to catch on that it's a really big problem. And it's addictive. It's the if you could see it in the brain. I mean, even since when I first met you, and we first started talking about till today, if you were to look at the research 10 years ago to now, I mean, there's moving research now where people are saying it's addictive, and it's really growing the knowledge now in this science.

Steve Martorano 
Well, we were for my entire life shown a pyramid - a food pyramid - that didn't have sugar in its proper place, and decided that fat would be the villain. And so they sold us food that they told us was low and fat, because fat was dangerous, and failed to point out that they were loading everything else up with sugar, which was really the killer. And it's funny how that works out when the sugar industry finances the research. But as you point out, that's changed. So we're learning a lot more about that. It's fascinating stuff. Do you see more people who you treat on the addiction end or the mood disorder side?

Dr. Rhona Epstein 
Because I know I'm unique in my specialty, I make sure that I'm out there. I make sure I'm...I do work with people who have anxiety and adjustment disorders and depression and other things. I work with couples, I work with other addictions. I work with families who have addictions, but I advertise. I wrote books and I speak on food addiction because I know I'm really one of only a very small handful of people who do this and I want to make sure people can find me.

Steve Martorano 
Well, let's talk about it in general, then, whether it's an addiction or you know, as you said, a mood disorder situation. Do we have any idea what causes someone to become addicted to food?

Dr. Rhona Epstein 
Well, yeah, there are a number of things. You have genetic factors, I believe actually I do histories with people who usually used to be addicted, other addictions. And I almost never meet a person with a food addiction who doesn't have something. It's either obesity in their family or eating disorders or alcoholism or other addictions in the family. You never meet somebody who just shows up as a food addict. There's also oftentimes trauma in the background. That's a very high percentage of people who have been abused. Growing up in a tough family situation with arguing and fighting. Our bullying. Everyone has a story. There's some kind of a story. Whether it's small traumas or big ones, there's usually some sort of trauma. And, you know, in with regards to the issue of a mood disorder, I always have the question, which came first, the eating problem or the depression, because you eat crap, you feel like crap. So, you know, like myself, I had a food addiction. And when I was a kid, I grew up on sugar, I might somehow or another, I was addicted to sugar when I was a tiny little kid. I mean, a lot of kids are like that. But my parents I got away with not eating anything, but sugar and white flour, all my childhood are lived on Pop Tarts, Captain Crunch, spaghetti, and Oreos, and you know, all the junk that you can get your hands on. I basically just lived on that. And you know, I think my brain was affected. I mean, my ability to think straight in school -- I was a terrible student, I didn't even know that I knew. And I thought it was dumb until I quit eating sugar. And then I became an excellent student. And mood-wise, I ended before I knew about eating disorders, I was in a counselor's office, and they were giving me a diagnosis of major depressive disorder. And when I stopped eating sugar, I magically did not have major depressive disorder. You know, what was the sugar doing to my brain? I mean, I wasn't properly nourished, I was living on not real food.

Steve Martorano 
The situation with food and eating all that really brings into the, to my mind, for most of this idea of CO-occurring situations anyway, anyone who's done any work in substance abuse will tell you, Okay, you can deal with what they're consuming, what they're abusing. That's just the beginning, something caused that. And that's the CO-occurring mental health side of this thing. That issue you just described with food is the perfect sort of battlefield for that war to be waged. So you see it and families in you see, it would seem to me that it's...it's...it's a very easily learned bad situation. I mean, you're right. If your parents feed you, as a youngster bad stuff, you're gonna learn to eat bad stuff. Right?

Dr. Rhona Epstein 
Right, exactly. That's right. I work with clients sometimes they only eat fast food their whole lives. They've never eaten and they don't know about healthy food at all. They've never been fed healthy food, they have no idea.

Steve Martorano 
Well, I just talk about some of the treatments that you have used with regard to someone who has strung out on food or sugar anyway. How closely does it model the treatment anybody would get who had a substance abuse disorder?

Dr. Rhona Epstein 
Well, okay, so with substances, obviously, we recommend abstinence from...

Steve Martorano 
A little tough in your field, right?

Dr. Rhona Epstein 
Well, it's not really I guess, once you understand. I mean, you know, we still drink you know? I drink water. I mean, a person who quits drinking alcohol still drinks water and soda and other things. They won't stop drinking. They just stop drinking alcohol. Right?

Steve Martorano 
Right. Makes sense.

Dr. Rhona Epstein 
We understand the difference between a mood-altering drink and a drink. that is not mood-altering. Right?

Steve Martorano 
Perfect. Yes. Yes. So nobody's talking about stopping eating?

Dr. Rhona Epstein 
No, we're not talking about stopping eating. We understand that there are foods that are addictive, and there are behaviors that are addictive behaviors. And you know, what we need to cut out are the things that are addictive, abusing food, like for example, can we be a normal person? You know, if they have a breakup, they can drown out their feelings in an ice cream binge. But like a food addict needs to understand that one ice cream binge and a breakup will be the end of their recovery. You have to find another way of handling your feelings without the ice cream. You know, the thing with food is a person who's in food recovery. You need to learn what's healthy eating, and you have to separate healthy eating from addictive eating and only do healthy eating and not addictive eating.

Steve Martorano 
With regard to self-medicating -- I personally know people. I watched it. I've worked...usually people I've worked with in stressful situations.

Dr. Rhona Epstein 
Oh yeah.

Steve Martorano 
They would sit and eat a meal. And I somehow knew they looked like they were enjoying it. They were eating. A lot of it. But it was really stress-induced. Food is a great way to self-medicate, right?

Dr. Rhona Epstein 
Oh, absolutely. Absolutely. They, you know, use sugar. In back in long many, many moons ago, they use sugar for medicating headaches and you know they use it now when Jewish babies are having a circumcision. They give him a little comfort.

Steve Martorano 
Well, we even talk about treating ourselves. Oh, you know, oh, you would treat me to two dozen doughnuts. It's all incredibly fascinating. And Dr. Epstein won't blow her horn, too loudly, but I will. I mean, this was a revelation to me a year or two. I guess it was longer than that now when we started

Dr. Rhona Epstein 
It's been many years since we started talking on the radio.

Steve Martorano 
Yeah, so it's just fascinating. A couple of kinds of eating disorders, food addiction questions, 101. What's the difference between bulimia and anorexia?

Dr. Rhona Epstein 
Well, bulimia is binge eating and purging. So the person has like 1000s and 1000s of calories, usually junk food, and just out of control, eating. They both have weight obsession and diet and restrictive eating, but the person who's anorexic doesn't typically, have an anorexic doesn't have the binge-purge side, they just have the most restricting side. You know, some people who are anorexic could have periods of both. I mean, there you have people who with complicated eating disorders have a whole wide array isn't usually either or, you know? I've met people who have periods of anorexia and periods of bulimia, they get on a roll when they figure out how to start restricting. And they...I mean, you get high on being skinny. It's a very different thing than getting high and checking out on the binge fruits. It's very different.

Steve Martorano 
Do you have any idea who is more susceptible to food addiction or eating disorders than other people? I mean, is there a typical person?

Dr. Rhona Epstein 
You know, I mean, if you were to look at what people would say, I mean, I think you see it like with anorexia, you typically would see wealthier, higher pressured families where there's more perfectionistic, higher standards, higher expectations, typically, I mean, that's not always true.

Steve Martorano 
Yeah.

Dr. Rhona Epstein 
You often times have these high achieving kids who are supposed to be A students who are pressured to be the best in all. They have to look the best. Be the best. No tolerance for any, any weakness. You know, and that sort of weight is just another one of those.

Steve Martorano 
Why do I think that women are more susceptible to this problem than men? Is it true?

Dr. Rhona Epstein 
I think it's true for anorexia, but it's not...there are men who have anorexia as well. I mean, especially, you know, you see that in different men who are involved in sports and athletes who...I see people...I have who...well, I don't want to say who, but... People around who are doing these competitions, and have to make sure they have no body fat, and they really have to do all that they can. And they're, you know, running so many miles. And I mean, I don't want to say they will have eating disorders, but...

Steve Martorano 
I've never seen a super marathoner or one of those Ironman people who ever looked healthy to me. You know, they looked like they could do that, but they didn't really look healthy. Anyway, the other question I had is, you know, I mentioned women because women are under more scrutiny than men when it comes to body type in the way they look and their appearance and all of that. So we all know, the role of things like social media and Instagram, in particular, had a devastating effect on young women with regard to the way they're supposed to look. I know you agree that that's been a factor. What do you think, though, about the swing in the other direction, that says, well, for the lack of a better phrase, "big is beautiful." So suddenly, and they call the "plus-sized women" are to not be scorned? Or judged? As though I hate to use this expression, "fat is okay." How do you feel about that?

Dr. Rhona Epstein 
Good question. Well, on the one hand, I will say, I agree that people should never be shamed. So I do you think that you know, having worked for years with people who are obese, that fat shaming is so totally crushing to a person's soul? That there's absolutely no reason for it ever. And I don't think anyone unless you've sat and listened to people who have been body shamed, cannot begin to understand what it's like. And I think actually when you ask about reasons for eating disorders, the stories many, many, many of my...the stories I've heard over the years, there's a parent, or a friend or a cousin or something, somebody who was making body shaming comments during younger years, and it just creates this horrible sense of self. That person never gets out of their head. It's a terrible, awful thing. So no matter what size a person is, they should be cherished and loved, and, and celebrated, and no one should be shamed. No matter what size they are. So that's number one. The thing that's challenging about this is that they're staying healthy in all sizes. They're saying you can be healthy and obese. I don't know if that's really true. Is it really true? I mean, my clients who are overweight, have trouble walking, have circulatory problems, inflammation, skin problem, what are they eating? Are they numbing themselves? I mean, is this really a healthy lifestyle? It's not about the weight and the look. And I think that the problem is that in society, we've made such a big deal about appearance.

Steve Martorano 
Yes.

Dr. Rhona Epstein 
You know, that's the wrong point.

Steve Martorano 
Yeah, that's what troubles me about it, this is beautiful. And that's not the argument we're having, because you're right. bullying is bullying. But to say, an overweight person is endangering their health. Or not saying that I think is foolish. You can't be telling young girls, that it's okay to be very obese, no matter how many singers are achieving stardom, because, you know, they're overweight. Good for them, but it can't be healthy. I'm glad you and I agree with that because you're an expert.

Dr. Rhona Epstein 
Well, you know, when I think psychologically speaking, it's also like, for me as a person who, you know, I'm in recovery. And I understand today, you know, like what I was eating? There were reasons, first of all, is it healthy to be? are you abusing food? Because I don't care what you look like I care. Are you healthy emotionally? Are you healthy emotionally if you are numbing out your feelings? Are you caring about yourself if you're putting trashy food in your body? I mean, it's a self-care thing.

Steve Martorano 
Yeah. Yeah, it's very much like another...among young people who are stressed and confused and that's cutting and stuff like that. It's just another way of hurting yourself. Because you're in so much pain. Dr. Robert Epstein is our guest, as you can tell by now she knows what she's talking about. And what we're talking about are eating disorders and food addictions. And you're going to be hearing way, way more about food addictions going forward as people begin to realize what they've been fed, in addition to all the lies about a lot of bad food that has resulted in real addiction. I know it sounds counterintuitive to say, get me addicted to food, but well, you can. So we appreciate every time she comes in and joins us before we let you go, Rhona, we're sort of coming out the other side of the pandemic. I can't imagine the pandemic did anything but exacerbate all the problems you see, is that true?

Dr. Rhona Epstein 
Oh, for sure. I mean, people have been eating their way through the pandemic. The pandemic could have been an opportunity to, you know, you're at home, you can cook, you can exercise. You don't have to drive back and forth to work, you have a little extra time. It could have been used for self-care. And I think some people did use it for self-care. But I think for some people, the stress was so high the isolation, the boredom, that you know, some people just really lost their minds during the pandemic and all addictive behaviors, all unhealthy behaviors, just some people just don't do well alone and or in the stress of their family situations. You know, just not knowing how to handle the pressures of kids having to do school at home and all the things that we've you know, there's so much has taken place.

Steve Martorano 
Yeah, yeah, it goes well beyond the COVID 15 pounds that we all managed to gain if we're not careful. It's just been a devastating impact across the board. Finally, because this is National Recovery Month, and I've over that time talked to so many people now and got a new perspective, when we're...when we stay recovery. What are we talking about, particularly in the mental health area? It's important, as we said at the beginning, to remind people you can get better. So for you, you say you're in recovery from an eating disorder or food addiction, for people who are struggling, is it a question of whether they can actually recover? Or is it something they wind up having to just manage? What does recovery look like?

Dr. Rhona Epstein 
I do believe 100% that people can recover. Just like with substance abuse. I mean, in my opinion, it's bio, psycho, socio, spiritual. You got to deal with the physical by shutting down cravings by getting out the junk food so that you don't keep the addictive behavior alive in your body. If you get the substance out and deal with the physical by getting your food in its right place having a food plan that's structured and you learn to eat your food for nourishment, not for addictive use of emotional management and numbing out and all that. And so you get that real clear, okay? That's the physical than the emotional, you know, I mean, we're all eating to escape emotions, those of us who abuse any addictive behavior are all about escaping feeling. So that then becomes like, a big focus is what do I do too now do when I feel sad -- now do when I feel bored -- not feel when somebody dies -- now do when the stress at work is so high, I can't handle it. We're under financial stress. You know, there are a million things to eat every single day. You know, you have a fight with your spouse. You have an argument with, you know, one of your kids. You know, or you're lonely. The excuses, never end. Does recovery look like what are my skills now for managing all of my life things? If my food is in the right place, and I'm committed to a healthy food plan that gets everything that I need in my meals, not addictive eating, not restricting only my healthy eating. Now I have to get skills for managing my life and that involves being involved in a support group, I think in therapy, because it's true, you can't do it by yourself. People can't do this by themselves. There's tons of help out there. And free help 12 Step programs and the pandemic -- that's the gift of the pandemic. All the meetings are online now you can get so much help for free online all day and all night. You can go to meetings all over the world now. It's amazing. So there's no reason, no excuse for not getting help. And then the other thing is, I believe deeply that you know, having a psychic change, like a spiritual transformation, where you know, we you kind of create a spiritual life where you find peace and you find a spiritual relationship, something enables you to...to experience, you know, life in a different way. So you're you're thinking differently, and you're trusting more, and you have a better sense of well being in your life.

Steve Martorano 
Yeah, that last point is interesting, because it's often dismissed as religiosity or new age kind of stuff. But the truth is, as you point out, that if you can get to that spiritual place, it tends to cure a multitude of problems, all by itself. Rhona Epstein, thank you so much. Rhona is an accomplished clinician, obviously, medical professional. She's a great speaker on these topics. What is your website, you have a great website where people can find out more about you your practice and your writing.

Dr. Rhona Epstein 
DrRhona.com. D-R-R-H-O-N-A.com.

Steve Martorano 
It's great to see you again. Thanks so much for your time. We appreciate it. It's always a lesson for us here on the Corner. We appreciate it.

Dr. Rhona Epstein 
Thank you, Steve. It's a blessing to be with you.

Steve Martorano 
Thanks so much. Thank you all as well. Don't forget, follow us like us do whatever you have to hear on the Behavioral Corner. We'll catch you next time.

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