Latest / All Bodies. All Foods. / 43. Demystifying the Dietitian’s Role and Exploring Supportive Tools for Eating Disorder Recovery with Emily Murray, RD, LDN, CEDS

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43. Demystifying the Dietitian’s Role and Exploring Supportive Tools for Eating Disorder Recovery with Emily Murray, RD, LDN, CEDS · All Bodies. All Foods.

0:00
Hey,
0:01
I'm Sam.
0:02
Hi,
0:02
I'm Ashley.
0:03
And you're listening to All Bodies All Foods presented by the Renfrew Center for Eating Disorders.
0:09
We want to create a space for all bodies to come together authentically and purposefully to discuss various areas that impact us on a cultural and relational level.
0:19
We believe that all bodies and all foods are welcome.
0:23
We would love for you to join us on this journey.
0:26
Let's learn together.
0:28
Welcome back to another episode of All Bodies All Foods.
0:33
Today we're gonna discuss the critical role of a dietician on the care team of someone with disordered eating or an eating disorder.
0:41
As we are aware that eating disorders are so much more than just the food,
0:45
the food or lack of food can be a tool used to manage the larger emotional experience.
0:51
And we know that this can leave our folks with eating disorders often finding themselves knee deep in a toxic relationship with food eating disorder.
1:01
Dieticians are critical members of the team because they can support folks alongside the therapist to determine what and how their clients bodies need to be nourished and fueled eating disorder.
1:14
Dietitians can assist with fear foods and alleviate confusing questions.
1:18
One might have about food based on the onslaught of diet,
1:22
culture and social media offering ways to quote unquote live healthy.
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It's truly no wonder why we have more questions than answers around our relationship with food.
1:33
Lucky for us,
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we have someone on the show today who can speak to all of this from a dietitian's perspective because she is a dietitian.
1:41
I'm talking,
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we're gonna ask everything from what is a carb and why is it helpful for our bodies to explaining the principles of intuitive eating and health at every size and how these can offer food and mental health freedom.
1:54
I'm so excited to share with you all today that our guest is Emily Murray of Murray Nutrition.
2:00
Emily received her undergraduate degree in nutrition and dietetics from Tennessee Technological University and completed her dietetic residency at Vanderbilt University Medical Center and Vanderbilt Children's Hospital in Nashville,
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Tennessee.
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She is in a variety of practice settings prior to establishing Murray nutrition including inpatient phpiop and outpatient levels of care for eating disorders.
2:28
Most notably with the Renfrew Center of Nashville,
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Tennessee.
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Emily is a certified eating disorder specialist through the International Association of Eating Disorder Professionals and she established Murine Nutrition P LLC in May of 2020 with a heart to provide compassionate clinically excellent nutrition care to individuals who suffer from eating disorders in the Greater Nashville area.
2:53
Emily,
2:53
thank you so much for being here with us.
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Today.
2:57
Thank you so much for having me.
2:58
I'm so excited to get into all of this awesome combo.
3:01
Yeah.
3:02
So I would love if we could just start out with,
3:05
um,
3:05
you kind of giving us a little bit of background information.
3:08
Like how did you get into working in the nutrition field and um,
3:13
specifically how did you get into working with eating disorders?
3:17
Yeah,
3:18
that's a really,
3:19
really,
3:19
really great question.
3:20
Um,
3:21
I got into the nutrition field looking to kind of like heal my irritable bowel syndrome from a functional place,
3:33
which you know,
3:34
there's a place for that.
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But what I didn't realize is that I had a whole lot of disordered eating which eventually kind of developed into an eating disorder,
3:42
not kind of it did.
3:44
Um Yeah.
3:45
And so like that really needed to be addressed before anything.
3:48
And then I also,
3:49
you know,
3:49
needed to address my anxiety and my nervous system.
3:52
And so that,
3:53
yeah,
3:54
so I went into the field to do like,
3:56
you know,
3:57
one thing and kind of,
3:59
you know,
3:59
really realize like,
4:00
wow,
4:01
through my own recovery,
4:02
this would be so cool to help other people do the same thing and hear these types of messages that I've heard in my recovery and really hear the truth about,
4:11
you know,
4:11
a lot of what our bodies really need and how,
4:14
you know,
4:15
how relationship with food and anxiety and all of that impacts food and health and all of that.
4:20
So that's how I got into it.
4:23
Oh,
4:23
wow,
4:24
Emily.
4:25
Thank you so much for bringing this up.
4:27
Thank you for being on the show,
4:28
first of all.
4:29
Um,
4:29
but,
4:29
you know,
4:30
a lot of people don't realize that there's a connection between people with G I issues and eating disorders.
4:38
And I'm so grateful for you to bring this up because there are so many people out there,
4:42
I think that can relate that they,
4:44
they go into sort of dieting or changing their,
4:49
you know,
4:49
the way they approach food in the hopes of like hearing some kind of a G I issue and then they end up developing disordered eating or an eating disorder.
5:00
And it makes perfect sense and it's like they start cutting out certain foods or,
5:05
you know,
5:05
they think,
5:06
oh,
5:06
if I just eat this way it's gonna cure it.
5:08
And then next thing,
5:09
you know,
5:10
you know,
5:10
they're struggling with their relationship with food,
5:13
which reminds me,
5:15
you know,
5:15
I'm,
5:15
I'm thinking about clients who come into treatment who are brand new to sort of eating disorder recovery.
5:21
And one of the first questions they ask,
5:23
it's like,
5:24
why are you making me eat carbs?
5:27
Because carbs are so villainized in diet culture.
5:31
And I thought we could just jump right in and talk about carbs because there are probably listeners thinking,
5:37
you know,
5:37
are carbs really that important.
5:40
Why do we need them if they are so important?
5:42
Then why are we hearing all the time in diet culture that when we shouldn't eat them?
5:48
Can you please enlighten us?
5:51
Yes.
5:52
Yes.
5:52
Well,
5:53
and there's just so much misinformation out there and there's so much information and then,
6:00
and then there's also a lot of misinformation and especially for people like myself who have,
6:06
you know,
6:07
maybe perfectionistic tendencies,
6:09
all or nothing.
6:10
Um,
6:11
you know,
6:12
it's kind of a default.
6:13
It can be really hard hearing,
6:15
you know,
6:15
some of this information about what car are aren't and even some of like,
6:19
even with like some of the G I stuff like gluten is terrible for you.
6:23
You know,
6:23
you're,
6:24
you have leaky gut,
6:25
you're eating carbs and that sort of thing.
6:27
So there's just like a lot of messages around it.
6:30
Um So carbs actually,
6:32
I think what a lot of people think of carbs,
6:34
they think of like red rice,
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pasta,
6:38
the potatoes and those are carbs,
6:40
you know,
6:40
but carbs also include fruits and vegetables.
6:42
They also include,
6:44
you know,
6:44
dairy has,
6:45
you know,
6:45
dairy are a carb source even though there's protein in dairy too.
6:49
So carbs is kind of the umbrella,
6:51
you know,
6:51
term for a lot of different foods.
6:53
But,
6:54
you know,
6:54
people really end up having a hard time with the foods that are higher in carbs,
6:58
right?
6:59
And really,
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that's unfortunate because carbohydrates are our body's preferred energy source.
7:06
Um So our,
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our muscles are organs,
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our central nervous system our liver,
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our heart,
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all of these really vital organs that keep us alive every single day.
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Like to get their energy from carbs and glucose.
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One,
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a form of carb and how,
7:25
you know,
7:25
carbs are broken down,
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they're broken down into glucose.
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A lot of them that glucose fuels our brains and I forget that we forget how much our brains do for us,
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you know.
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So it's easy to kind of be like,
7:39
oh yeah,
7:39
whatever carbs help my brain like I'm kind of having some brain fog like no like carbs help with our cognition,
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our thinking,
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our ability to problem solve and make decisions.
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It helps us with memory retrieval and sensory processing.
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Like carbs literally help our window of tolerance and it can help determine how we're able to handle what life can throw at us or not.
8:04
So,
8:05
yeah,
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I'm a big carb fan over here and yeah,
8:08
I mean,
8:08
that's just a little bit of what they can do for our bodies.
8:11
Can I ask a follow up question to that?
8:14
I'm so curious what it gave you Emily.
8:19
So you mentioned like kind of getting into this journey with like your own healing journey,
8:25
right?
8:25
Like getting into this dietetic world with your own healing journey.
8:28
What did that like a light bulb moment do for you when you realized that carbs were helpful?
8:37
Yeah.
8:38
Yeah.
8:38
So and this actually goes into a question that I saw on our little um outline just as I was planning and thinking about this conversation.
8:45
So I worked with a dietitian who was eating disorders in form and she actually recommended me to cut out certain carbs.
8:54
And so I did that for a period of time,
8:57
several months and I felt like crap.
9:00
I felt so bad.
9:02
I felt so so bad and that like kind of was the peak of my eating disorder.
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And I,
9:07
I was having a really hard time mentally emotionally and I was like,
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I don't know what's going on,
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but this is,
9:14
this is not it.
9:15
So I was kind of already at a breaking point of like,
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this thing is not working,
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maybe,
9:20
maybe I can eat anything,
9:21
maybe it's not really about the food.
9:22
Maybe I'm like,
9:23
I'm missing something.
9:25
And so I worked with a dietitian who is very well experienced with eating disorders and we kind of started off just like saying like,
9:32
hey,
9:32
we don't need to put anything out.
9:34
Like,
9:34
let's just kind of start gradually,
9:36
you know,
9:36
adding back in your tolerance level,
9:38
your comfort level,
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your stomach is probably not gonna feel great,
9:41
it's gonna be hard.
9:43
But like,
9:43
what you've been doing hasn't been working.
9:45
Let's,
9:45
let's see what this route goes.
9:47
And I found that like,
9:48
the foods that I was fearing like pizza and pasta,
9:52
I felt so good on,
9:53
I felt so much better on those foods.
9:56
Um,
9:56
that plus being in therapy,
9:59
learning how to,
10:00
you know,
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regulate my nervous system.
10:02
I felt like the best I had felt in years.
10:04
So,
10:05
yeah,
10:05
that's kind of how it for me.
10:07
Yeah.
10:08
And you,
10:09
so you started to mention this too.
10:11
The first dietician you saw was not eating disorder informed.
10:14
The second one was,
10:16
can you help us with that distinction for somebody that might be experiencing disordered eating or an eating disorder?
10:22
Why do they need to go to a dietician who is eating disorder informed specifically?
10:29
Yeah.
10:29
Yeah.
10:30
So the first dietitian um yeah,
10:33
just,
10:34
I don't know if she was really able to tell like,
10:37
how much I was,
10:38
I don't know if she was really even assessing my energy needs.
10:40
It was more about like gut health protocols and like,
10:43
you could try this cleanse.
10:45
Like my clients have had good experiences on this cleanse and it's like,
10:48
ok,
10:49
it's like cleanse is like a product that was being sold,
10:51
but it's also like my digestive system is not gonna work if I'm not eating enough.
10:55
So there was just a lot of nuance that was missed there.
10:59
And then at a point I actually told her like,
11:02
hey,
11:02
I think I might have an eating disorder.
11:03
What do you think?
11:04
And she was like,
11:05
no,
11:05
no,
11:06
like,
11:06
don't worry,
11:06
you don't have an eating disorder.
11:07
And I was like,
11:08
oh,
11:08
great.
11:09
But that really,
11:11
I like slid under the radar.
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And so that was kind of like she just didn't,
11:15
she just didn't know,
11:16
she just did not know.
11:17
Um,
11:18
and in my second experience,
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like,
11:21
it's just like every time I would say something that my brain was telling me it was just like,
11:27
oh,
11:28
yeah,
11:28
like,
11:28
not surprised by it.
11:30
Right.
11:30
And knew how to kind of,
11:32
what to say back to that and knew how to handle it and really helped me differentiate between kind of my healthy self and kind of those eating disorder.
11:41
Thoughts worked really closely with my therapist on my team and yeah,
11:46
it was just so much,
11:47
much different experience and someone who really,
11:50
who wouldn't,
11:51
like,
11:51
who wouldn't give into my eating disorder.
11:53
Like sometimes,
11:54
you know,
11:54
even months after I would come up and be like,
11:56
hey,
11:57
I think I need to cut some things out.
11:58
Like I'm,
11:59
my stomach's been hurting.
12:00
What do you think?
12:01
And she's like,
12:03
you know,
12:03
I don't think that that's the route we need to go.
12:06
You know,
12:06
you've been feeling really good,
12:07
you know,
12:08
there's other stressors,
12:09
you know,
12:09
just like a sounding voice of reason that it really knew and helped me get healthy and come back to life,
12:16
which was such a blessing.
12:19
It's so important to work with providers that understand eating disorders and have experience with eating disorders because unfortunately some of the recommendations and interventions end up just making people worse.
12:31
Yeah.
12:31
Yeah.
12:32
Yeah.
12:34
So question another,
12:37
another couple of set of questions here,
12:39
Emily.
12:40
Um,
12:40
in this field,
12:42
we hear a lot of terms thrown at us.
12:45
So I have kind of listed out a couple of terms that I would like to ask if you would feel comfortable just like helping us understand a little bit more.
12:56
Um So the first one is the term or the phrase all foods fit.
13:02
Um What does that mean?
13:03
And what does it not mean?
13:05
I love this,
13:06
I love this question because it's confusing on social media and there's not always nuance that we need.
13:12
So,
13:12
you know,
13:13
all foods fit that does not mean that you have to eat all foods.
13:16
It doesn't mean that you have to eat foods that you don't like.
13:19
It doesn't mean that you have to like blow past your,
13:22
you know,
13:23
pull this,
13:23
it doesn't mean any of that.
13:24
It means that,
13:26
you know,
13:27
you're,
13:27
it's really going to be um a benefit to you in,
13:31
in building a lasting um sustainable healthy relationship with food for you to allow yourself to eat the foods that you want to eat,
13:39
you know,
13:39
and not put arbitrary restrictions on what you can and cannot eat based on what someone else is doing or what you read on the internet or what your mom said you need to do.
13:51
But based on like what your body wants and needs and we're not restricting those things.
13:56
So all foods that make sense for you,
13:58
you know,
13:58
if you have,
13:59
you know,
14:00
celiac disease No,
14:01
we're not saying that you need to go eat,
14:03
you know,
14:04
regular gluten filled bread.
14:06
That's not what we're saying.
14:07
It's,
14:08
you know,
14:08
foods that make sense to you and how not restricting those things can really open up your world and relationship with food eating and all of that.
14:17
Ok.
14:18
That's helpful.
14:19
All right.
14:20
The next one.
14:21
What is a food rule or what is a food ritual?
14:26
Yeah.
14:27
Yeah.
14:27
So these are,
14:28
these are really,
14:29
I'm just like loving this conversation.
14:31
These are really good.
14:33
So a food rule,
14:36
um,
14:37
is something that can come up in a person's brain when they struggle with um,
14:43
eating disorders,
14:44
disordered eating that it's just kind of like,
14:47
it's not,
14:48
it's not a guideline.
14:49
It's not like a self care situation,
14:53
you know,
14:53
it's not like,
14:54
yeah,
14:55
eating breakfast,
14:56
you know,
14:57
could help you feel good in the morning.
14:58
That's not really what it is,
14:59
right.
15:00
It's like,
15:01
it's,
15:01
it's meant to,
15:03
it's normally has an eating disorder motive.
15:06
So it's like,
15:06
it's meant to reduce anxiety.
15:08
It's meant to shrink your body.
15:11
It's meant to help you eat cleaner than everyone else like that sort of thing.
15:17
So it's rules that maybe someone has heard from diet culture or a peer or a family member that can become so rigid and inflexible that it,
15:27
that it ends up being suffocating.
15:30
Um,
15:30
and sometimes it's nutrition guidelines that can be taken and twisted,
15:34
you know,
15:35
into a rule like for example,
15:37
something that I often hear people say is like,
15:39
yeah,
15:40
I have this rule that I can't eat dinner past seven.
15:45
It's like,
15:45
ok,
15:46
you know,
15:46
like,
15:46
where might that have come from?
15:49
You know,
15:49
and in general it seems like you like eating dinner between six and seven.
15:54
So that rule like,
15:55
you know,
15:56
it kind of makes sense for you.
15:57
But you know what happens if you get caught up or if a friend asks you to go to dinner at 730 or if you're studying and you get hungry and want a snack,
16:06
right?
16:07
That's when it can become like a life impairing rule.
16:10
And so we want to really strategically challenge those in treatment.
16:13
And then the food ritual is anything that you,
16:17
any sort of behavior that you do with food that is aimed to just reduce anxiety.
16:22
It's definitely can have like an obsessive compulsive flair to it,
16:27
you know,
16:27
so it could be like,
16:28
OK,
16:28
I can get through this meal,
16:29
but I have to rip it up into really small pieces or I can get through this meal,
16:33
but I need 50 minutes to complete it,
16:36
that sort of thing.
16:37
So these are the things that we're targeting in treatment,
16:40
really looking at some of those food rituals and eating behaviors.
16:45
So,
16:45
and that's something too that eating shorter um dietitian can really help with like they're,
16:51
they're prone to asking about food rituals and how long you know,
16:54
things don't slip under the radar as easily.
16:58
OK.
16:58
And we,
17:00
like,
17:01
we all have food rituals though.
17:03
Right.
17:04
Mhm.
17:05
What could you tell us some examples of what a food ritual could look like?
17:11
Like,
17:12
I've got one in my mind but I want to hear from you if you have other examples.
17:16
Mhm.
17:17
Mhm.
17:18
Yeah.
17:18
So,
17:19
um yeah,
17:20
kind of like,
17:20
so tearing up food into smaller pieces or like,
17:23
I have a piece of bread,
17:25
I'm gonna like,
17:25
tear it and then dunk it in my soup or whatever or when I have oatmeal,
17:31
I only do peanut butter with it.
17:34
I never can do like almond butter or nutella or just butter or something like that.
17:40
And the,
17:42
I think it's important to differentiate between like a food preference and a food ritual.
17:47
So,
17:48
like,
17:48
you know,
17:48
maybe I'm trying to think of something that I like to do do do do,
17:54
do,
17:54
do,
17:54
do you or what,
17:56
what's the example that you had?
17:57
Ok.
17:57
So when I,
17:58
when I talk about this a lot,
18:00
um,
18:01
when I teach about eating disorders,
18:03
I talk about an Oreo Cookie.
18:04
Do you know where I'm going with this,
18:06
Emily?
18:06
Yeah.
18:07
So,
18:07
like,
18:09
you know,
18:09
we all have our different ways of eating Oreo cookies and that tends to be OK.
18:15
Some of us untwist them,
18:17
some of us dunk them in milk,
18:18
some of us just take a bite.
18:20
Um,
18:20
we all have different ways and,
18:22
and they tend to be pretty strong people,
18:24
like a certain,
18:25
well,
18:25
I guess you said a preference or a way of eating it.
18:29
So that's not necessarily harmful if you will that food ritual,
18:34
the way that we eat the Oreo cookie.
18:36
However,
18:37
if like,
18:38
we're working with somebody in treatment and they want to open the Oreo cookie and eat the cream out and like,
18:47
they're like,
18:47
I can't just do that.
18:48
I can't just bite the cookie.
18:49
I have to like,
18:50
open it up.
18:51
Is that the kind of thing that we really want to target and like,
18:55
help them understand.
18:56
OK,
18:56
so we might be using this as a tool to manage,
18:59
like you were mentioning earlier,
19:00
manage that anxiety a little bit.
19:02
Um And these are the things that we want to challenge and the reason that we want to challenge them is the food rituals can be like socially disconnecting at meals.
19:12
You know,
19:12
like they can,
19:13
they can really get clients like in their heads and,
19:16
you know,
19:16
a lot of clients are like,
19:17
yeah,
19:17
I wanna be able to go and have like this meal with my friend without having to cut it into like,
19:24
you know,
19:24
20 different pieces.
19:26
And then like,
19:26
I look up and I'm like,
19:27
oh my gosh,
19:28
what did she just say to me?
19:29
You know,
19:30
so it's really like,
19:31
that is really a big motivator for people.
19:34
I guess it's hard to,
19:35
you know,
19:36
it's hard to sit you know,
19:37
with those food rituals without doing them.
19:39
But yeah,
19:40
it targets the anxiety and why do we want to target the anxiety because that can get in the way of like living a life that we wanna live?
19:46
Yeah,
19:47
that makes sense.
19:48
Um Yeah,
19:48
I think it's so important to check in with a client too.
19:51
It's like,
19:51
what's your intent,
19:52
like what's the intention behind the ritual?
19:55
And also to differentiate between,
19:58
you know,
19:58
for neurodivergent folks,
20:00
is this like a sensory issue or is this a food ritual that's like rooted in the voice of the eating disorder?
20:07
It tells you if you do this,
20:09
it will help you lose weight or it will help you,
20:11
you know,
20:12
it can be so tricky,
20:13
but I think everyone's so different and it's so important to differentiate between preferences and sensory issues and food rituals.
20:20
And it's,
20:21
that's why it's so important to have a dietitian who like understands the difference between these things.
20:26
So,
20:27
yeah.
20:27
So Ashley,
20:28
what was your next question?
20:30
Well,
20:30
I I was also just gonna say,
20:32
I feel like that like having these conversations with the eating disorder,
20:35
dietitian can just give our clients so much freedom,
20:39
right?
20:39
Or just like so much awareness and like,
20:41
oh that's why I'm engaging in this or that's why I'm doing that.
20:45
Oh This is making sense like it,
20:47
I feel like it connects the dots in a way that may have not been connected before.
20:52
Um So,
20:53
so in that connecting another dot What is haze or health at every size?
21:02
Um And what does it mean to be haze aligned,
21:06
I guess in the nutrition world,
21:08
in the eating disorder world,
21:10
et cetera.
21:11
This is such a good question,
21:12
especially when folks are like,
21:14
looking for a dietician.
21:16
And how did you know what can they expect from like a HAZ align dietitian versus like what are some signs that maybe they're not a HAZ align dietician?
21:26
Yeah.
21:26
Yeah.
21:27
Yeah.
21:27
Yeah.
21:28
Yeah.
21:28
Ok.
21:29
Ok.
21:30
Yeah.
21:30
So health at every size is a movement and a framework um that really,
21:37
you know,
21:37
emphasizes and advocates for kind of five different things.
21:42
So weight inclusivity,
21:45
um health enhancement and you know,
21:48
really saying like any person in any,
21:50
anybody can pursue health if they would like,
21:53
it's not a moral imperative,
21:54
like you're not good or bad for pursuing health or not pursuing health.
21:57
But,
21:58
you know,
21:58
it's like if you want to pursue health,
22:00
um you should be able to,
22:02
right?
22:02
And you shouldn't,
22:03
you know,
22:03
experience,
22:04
you know,
22:05
weight stigma at your doctor's office like that whole sort of thing like everyone who wants care and positive health should be able to pursue that.
22:12
Um The third thing is eating for well being,
22:15
eating for nourishment,
22:16
having that positive relationship with food,
22:18
uh respectful care.
22:19
So that goes back to like,
22:20
you know,
22:20
getting,
22:21
you know,
22:21
adequate,
22:22
you know,
22:22
excellent care at your doctor and then life enhancing movement.
22:26
So those are kind of the five foundational pillars that really kind of make up health at every size.
22:34
Um What was the second part of your health at every size within eating the sort of diet?
22:40
Yeah.
22:41
Yeah,
22:41
like what does it mean to be aligned with health at every size?
22:46
Um Yeah,
22:46
so really practicing that,
22:49
you know,
22:49
practically as a dietitian,
22:51
it means like,
22:53
yeah,
22:53
I think first and foremost,
22:55
honoring like where my clients are at and what they really want in terms of their health and recovery journey.
23:02
And,
23:03
you know,
23:03
sometimes that means doing things like taking a break from movement in order to ultimately have a really positive relationship,
23:12
you know,
23:12
with movement,
23:13
but sometimes we need a break from that,
23:15
right?
23:16
It means like not having really rigid um weight goals in the sense of like,
23:23
OK,
23:24
you know,
23:24
I need your weight to get here and then once it's here,
23:27
you're not allowed to gain any more weight.
23:29
It's like only here,
23:30
right?
23:31
Um It's,
23:32
you know,
23:32
not saying to,
23:34
you know,
23:34
clients of different bodies like,
23:36
OK,
23:37
this person is only allowed to have this amount of food and this person can have this much food,
23:42
but not more than that,
23:43
you know,
23:44
it's really treating everyone with,
23:46
with dignity and care and being aware of,
23:48
you know,
23:49
weight stigma and anti fat bias and doing that work personally.
23:52
And yeah,
23:53
just really um not letting that influence the way that I interact with clients.
23:59
Hm.
24:00
I also like how you said,
24:01
doing that work personally.
24:03
I think it,
24:04
in this field it is our responsibility to um understand how these movements and philosophies like land with us as well.
24:16
Um,
24:17
yeah.
24:18
Oh,
24:18
absolutely.
24:19
Emily,
24:20
I'm curious,
24:20
I'm sure you've had clients come in your office and because of diet culture and because of internalized weight stigma they may say to you,
24:29
I wanna pursue health and I know I have to do that by losing weight.
24:34
Yeah,
24:34
if they're open to it,
24:35
how do you help them shift their mindset around that?
24:40
You know,
24:40
the thing that comes to my mind first off is that weight is not a behavior.
24:44
And so there are for everyone,
24:46
you know,
24:46
there are health enhancing behaviors that we can look at maybe increasing or enhancing in our own life and world um that we can look at,
24:58
you know,
24:58
and kind of holding that weight piece.
25:01
Um having a loose grip around that like,
25:02
hey,
25:03
you,
25:03
you could lose weight doing this.
25:05
So you might not lose weight doing this,
25:07
you could gain weight doing this.
25:08
We're not really sure,
25:09
but these things will absolutely enhance your health.
25:13
And so that's one piece and if that's there,
25:16
but there's still this like,
25:17
burning desire to lose weight like OK,
25:20
is it,
25:20
is there a body image piece to this?
25:22
You know,
25:23
is there more that we need to look at and,
25:25
you know,
25:25
we never like shame anyone for wanting to lose weight.
25:28
Like we just have to get really honest around like,
25:31
you know,
25:31
what's the cost of pursuing,
25:33
you know,
25:33
weight loss above all else?
25:35
And uh you know,
25:36
do we really want to go down that rabbit hole?
25:39
So we really let you know,
25:40
we're all about body autonomy and giving clients choice and most clients know that we are not like weight loss dietitians.
25:47
We're not going to cut anyone's calories or,
25:49
you know,
25:50
promise anything like that.
25:52
Um And we will also meet a client where they're at prioritizing their health and well being first and foremost,
25:59
what a great answer.
26:01
Thank you so much.
26:03
Um Oh Shifting gears a little bit.
26:05
That reminds me um you know,
26:07
one thing that comes up a lot in eating disorder treatment uh because eating disorders can cause so much harm physically many times folks come in and their hunger and fullness cues are completely out of whack.
26:21
Yeah.
26:21
And I was hoping you could just say more about that.
26:24
Um You know,
26:25
maybe why does that happen?
26:28
What should people in recovery expect when it,
26:31
when it comes to their hunger,
26:32
fullness cues?
26:34
Um You know,
26:35
what have you noticed when people maybe start to notice them again?
26:40
And,
26:40
and what's that experience like?
26:42
So I was just hoping you could shed some light on that whole process.
26:48
Yeah.
26:49
Yeah.
26:49
Absolutely.
26:50
Yeah.
26:50
So a lot of times people come in and their hunger cues have been ignored for so long because the eating disorder has really told you to do that,
27:00
um,
27:00
told the clients to do that.
27:01
And so,
27:02
you know,
27:03
when something is constantly ignored,
27:06
um,
27:06
like hunger cues,
27:08
the body is kind of like,
27:09
ok,
27:10
maybe I don't need to send these anymore.
27:12
You're not gonna listen to them anyways.
27:14
Right.
27:15
So that is something that can definitely happen also,
27:18
if we're not eating enough food,
27:20
it's like our,
27:22
you know,
27:22
sometimes our,
27:24
our,
27:24
you know,
27:24
our basal metabolic rate is lowers in general and our bodies only spend energy on what's most important like keeping us alive.
27:33
And so,
27:34
you know,
27:34
hunger is a part of that for sure.
27:36
And some people experience increase hunger like whoa whoa,
27:39
whoa I'm so hungry.
27:40
Why am I so hungry?
27:41
Am I addicted to food?
27:42
It's like,
27:42
no,
27:43
you're hungry and your body is trying to protect you and other people just like have just don't have hunger,
27:47
right?
27:48
And that's just total body disconnection.
27:49
So we see both for sure.
27:51
Um we see,
27:52
you know,
27:52
extreme hunger,
27:53
we see no hunger all across the spectrum.
27:55
So if you're listening,
27:57
you're normal wherever you're at.
27:59
Um So yeah,
28:01
that's definitely um 11 piece of it and yeah,
28:05
fullness wise can be really tricky too because when a person goes from not eating enough to,
28:11
you know,
28:12
eating more regularly or eating but then compensating and trying to not compensate or something like that or struggles with binging behaviors,
28:19
those cues are,
28:20
are just so off,
28:21
you know.
28:22
Um,
28:22
it's not uncommon for people to take a couple bites of something and be like,
28:27
I'm so full,
28:28
right.
28:29
When digestion really becomes slowed down when a person is mal and when a person is malnourished,
28:36
um,
28:37
it's kind of the same thing like,
28:39
um,
28:40
yeah,
28:40
if you just haven't moved your body for like a year,
28:43
2345,
28:44
10 years and then you go,
28:46
you know,
28:47
you go back to the gym for the first time,
28:49
like your body is gonna be sore,
28:50
right?
28:51
And so that's kind of what can happen in the digestive track.
28:54
Like there's gonna be some soreness,
28:56
there's gonna be some pain and discomfort and that really is going to be there until the digestive system um gets used to being used in the way that it's supposed to be used.
29:08
And um also when we,
29:10
when we're eating enough,
29:11
like the me the metabolism and the digestion is going to kick back up to move food through more quick,
29:18
more quickly,
29:20
you know,
29:20
it's really common for people in recovery to feel like scared,
29:24
even of hunger and fullness.
29:26
Like we've been so disconnected from our bodies for so long.
29:31
And then all of a sudden we're,
29:33
we're feeling all these emotions,
29:35
we're feeling all the hunger and fullness and it's like,
29:37
oh gosh,
29:39
you know what's really happening right now can feel really scary and for hunger in particular it can feel like wrong.
29:45
It can feel,
29:46
you know,
29:46
diet culture,
29:47
like you're,
29:47
you're probably not hungry,
29:49
you're probably just thirsty.
29:50
Right?
29:51
It can feel.
29:52
Mm.
29:52
Yeah.
29:53
And scary.
29:54
So,
29:55
a lot of it's like,
29:56
you know,
29:57
I'm just like,
29:57
normalizing that.
29:58
I'm cheerleading it.
30:00
I'm like,
30:00
your body is doing exactly what it needs to be doing.
30:03
This is a good thing.
30:05
Um,
30:06
that sort of thing.
30:07
So,
30:07
yeah,
30:07
it's definitely complex and a lot of the work we do even,
30:11
you know,
30:11
once we're eating regularly enough is really kind of teasing out between all the different bodies,
30:16
sensations,
30:17
hunger,
30:18
fullness and emotional states and how those can even feel like hunger and fullness sometimes.
30:23
It's,
30:24
yeah,
30:24
it's interesting stuff,
30:25
but that's just a glimpse of,
30:27
you know,
30:27
kind of some of the stuff we do with hunger and fullness.
30:30
This kind of reminds me of like,
30:32
this is a therapeutic concept,
30:34
but I can totally see it playing out here in the nutrition lens too.
30:38
But that eating disorder work is not about feeling better,
30:43
but it get,
30:44
but about getting better at feeling.
30:48
And so like,
30:49
I think in the long term,
30:51
yes,
30:51
you feel better,
30:51
right?
30:52
But like this initial like starting to see a therapist starting to see a dietician,
30:57
like you're learning how to feel again.
31:01
And that just thinking about the hunger,
31:04
fullness cues like specifically,
31:06
I'm thinking about like the fullness cues,
31:08
like how scary to anyone on the spectrum of an eating disorder is that to feel that sense of fullness again,
31:19
like you mentioned,
31:20
feeling wrong or bad for feeling full or like if I'm feeling full and I've been engaging in,
31:28
in binging patterns for so long,
31:30
like I,
31:31
I like am connecting and I'm knowing there's a stopping point right here even though I wanna keep moving forward.
31:38
But do you know what I'm saying?
31:39
Like I just feel like it's,
31:41
I feel like it likely leads our,
31:44
our folks and our clients to,
31:46
to having a lot of emotional experiences,
31:50
but that's ok.
31:52
I mean,
31:52
we need to have that,
31:55
you know,
31:56
we need to have these emotional experiences.
31:58
Um But it definitely does just seem like it might be a little scary.
32:04
I don't know.
32:05
Yeah.
32:06
Yeah.
32:06
And I think it's,
32:07
you know,
32:07
another piece of it and what's really important is to even just look at like,
32:12
how am I interpreting fullness.
32:14
Um So I will never forget,
32:17
I will never forget it in my eating disorder recovery.
32:19
I,
32:19
so I did forget this detail.
32:20
I don't remember if I was married or dating my husband,
32:23
but I remember we both had a meal together and I was so full and I was kind of like,
32:28
oh my gosh,
32:29
I'm so full.
32:29
This is so awful.
32:30
But,
32:30
you know,
32:31
all the eating disorder thoughts and my husband was like,
32:33
hm,
32:34
I'm so full.
32:35
That feels so good.
32:37
And I was like,
32:38
like,
32:38
is that possible to think that fullness is good?
32:42
What if fullness is just like a neutral,
32:45
you know,
32:46
and that was really a formative experience for me,
32:49
like,
32:49
wow,
32:49
people interpret this differently.
32:52
What if I interpreted it differently?
32:54
So,
32:55
yeah,
32:55
that's something I'll share with my clients at times and they're also like,
32:58
he's crazy.
32:59
And I'm like,
32:59
no,
32:59
it's not.
33:01
But I'm like,
33:01
is it possible to feel satisfied and good in that fullness?
33:07
Yeah.
33:08
Or it's like,
33:09
what's the story you tell yourself?
33:11
Right.
33:12
Right.
33:14
So Emily,
33:15
you've given us like,
33:17
it's such amazing rich content.
33:19
Like,
33:19
thank you so much.
33:20
We really,
33:21
um we really wanted you as a nutrition expert on here to kind of talk about these principles that,
33:29
you know,
33:29
we've probably discussed on and off um in the show over the years.
33:34
But I'm just curious,
33:35
is there like,
33:36
what might be um anything that we missed that?
33:40
Like you specifically target and work on as an eating disorder dietician?
33:45
Um Yeah.
33:46
What are some different areas that you want to um work through with your clients?
33:54
Yeah.
33:54
Yeah.
33:55
This is a really good question.
33:56
So what we really prioritize is that um nutrition repair or nutrition stabilization?
34:03
Like,
34:04
you know,
34:04
getting to the place where we are eating enough,
34:07
we are eating enough food consistently without,
34:10
you know,
34:10
using those eating disorder behaviors to really make up for it at all.
34:15
So that's really what we focus on first with our clients.
34:19
And then we get into the more nitty gritty of like the food rituals and maybe really specific food rules and things that maybe work kind of at the bottom of the barrel easier to target,
34:31
but are more of the higher level like OK,
34:33
once we've mastered here,
34:34
then we can kind of move up here.
34:36
Um And then we move into even more of that intuitive eating embodiment,
34:41
embodied eating,
34:41
that sort of thing uh with our clients.
34:44
And I think that the two things that are coming to my mind in terms of like,
34:48
what's just helpful to know.
34:50
I think a lot of people,
34:51
especially,
34:52
you know,
34:52
if they're discharging from a place like Renfrew or something like that,
34:56
like they'll ask,
34:56
like,
34:57
do I need to see a dietitian and a therapist?
34:59
Like,
35:00
you know,
35:00
do I really need both that sort of thing?
35:02
And,
35:03
you know,
35:03
one thing to think about is like,
35:05
eating disorders are so strong and sneaky and so is diet culture.
35:09
And it's like,
35:11
even if you saw a dietitian and a therapist once a week,
35:15
that's two hours out of your week where you're kind of being poured into and fed,
35:20
like all the positive,
35:21
you know,
35:22
interventions and information and I don't know how many hours are in a week,
35:26
but it's a whole lot more than two.
35:28
And so even just like that alone is so,
35:32
so,
35:33
so important.
35:35
Um So,
35:36
yeah,
35:37
I mean,
35:37
I just like to tell,
35:38
to tell people that like,
35:40
you know,
35:40
you just,
35:41
it's,
35:41
it helps you get better quicker when you have,
35:44
you know,
35:44
that on your side and um,
35:46
you have a team in place.
35:48
I think the other part of my job that I totally forget about sometimes and underestimate is my ability to help,
35:56
um,
35:57
reduce shame.
35:59
So that is just there so often of like,
36:03
yeah,
36:04
I mean,
36:04
I sat down for this meal but then like my brain was doing all these things and then I like ate the meal but then I felt,
36:09
you know,
36:09
and it's like,
36:10
yeah,
36:10
you know what I would expect for your brain to do that right now because you have an eating disorder,
36:15
right?
36:15
And that's ok.
36:16
We here,
36:17
you know,
36:18
there's nothing totally horribly wrong with you that you,
36:21
that you're in recovery,
36:22
but it's ok.
36:23
Right.
36:24
And really helping with that I think is like,
36:28
I love that part of my job and I forget like that's a really powerful nutrition intervention that we're doing.
36:34
Oh,
36:34
yeah.
36:35
Yeah.
36:37
You know,
36:37
one thing,
36:38
um that comes up a lot.
36:40
Speaking of shame,
36:41
you know,
36:42
when I work with clients in recovery and they have family and friends who are still really deep in diet culture and maybe are commenting about,
36:52
you know,
36:53
their food or talking about their diet and are there tools that you can give clients to navigate that because it's so hard.
37:03
Mhm.
37:04
Yeah.
37:05
I mean,
37:05
I think we,
37:06
like,
37:06
we have to normalize how hard it is and,
37:09
and painful.
37:10
It,
37:10
it's the same thing.
37:11
Like,
37:12
if someone's in recovery from,
37:15
you know,
37:15
alcohol,
37:16
you know,
37:17
misuse or addiction process,
37:19
like,
37:19
it would be really challenging,
37:21
annoying,
37:22
frustrating if they were around people that were,
37:24
like,
37:24
drinking all the time and normalizing that and cheering in front of them,
37:28
like that would be horrible.
37:31
Um And it's like,
37:32
that's really what a lot of our clients go through.
37:35
Um So,
37:37
you know,
37:37
and it's really easy,
37:39
you know,
37:39
speaking of shame to go to that place of like,
37:41
there's gotta be something wrong with me for not doing all of this,
37:45
you know,
37:46
it's really easy to go there.
37:48
So having people in your life that are not doing that,
37:54
you know,
37:54
it might start with just your treatment team,
37:56
but then,
37:57
you know,
37:57
gradually expanding that circle can be really,
38:00
really reparative and healing.
38:02
Um Really trying to challenge that shame narrative,
38:05
like,
38:05
is there something wrong with me or is there something wrong with our culture that it's making everyone feel like they have to be doing this stuff and only the select few of us have been enlightened so far.
38:18
Um But,
38:19
you know,
38:19
really kind of challenging that story of like,
38:21
is there another possibility?
38:23
Is there another story here?
38:24
Is this quick answer really?
38:26
What's happening or is there something deeper?
38:29
Um Yeah,
38:30
I think,
38:31
you know,
38:31
those are some of the biggest ones and just trying to have boundaries around like what your nervous system can and can't tolerate when it comes to comments,
38:39
when it comes to what you're taking in what you're seeing,
38:42
whether that be interpersonally on social media at work,
38:46
whatever that needs to look like.
38:47
But yeah,
38:49
just trying to get curious around like,
38:50
what are my boundaries?
38:52
What do I need to feel grounded?
38:53
I'm not being mean.
38:55
I'm just like taking care of myself and that's ok.
38:58
So we definitely talk about that because that will come up of like,
39:01
I had this plan to do this thing with this meal and then this happened and then it like it all messed up.
39:05
And so we'll talk about stuff like that too,
39:07
for sure.
39:08
Yeah.
39:08
Yeah.
39:09
Thank you.
39:10
That makes me think Sam and I have talked uh you know,
39:14
at length about social media on the podcast and like,
39:18
even because so much of like diet culture and,
39:21
and fat phobia and all that exists on social media,
39:24
even tailoring or adding like one person in or one like social media account on all of your accounts that,
39:33
that you know,
39:35
says something different than diet culture or um talks about like the harm of fat phobia and stuff like that even adding just one person in,
39:45
even if you can't take anybody out yet,
39:47
but getting that different voice in there can be so helpful.
39:53
Um Not only then are they getting that voice from the therapist?
39:56
Not only are they getting that voice from you the dietician,
39:59
but now somebody you know,
40:01
in the realm of culture and social media is,
40:04
is adding to it.
40:05
I mean,
40:06
we would love for them to shift all of their social media,
40:10
right?
40:11
Um But even just adding in one extra voice could be helpful,
40:15
I would think.
40:16
Yeah.
40:16
And then like,
40:17
noticing how do I feel when I listen to this voice versus this voice,
40:22
you know,
40:22
like,
40:23
what is there to learn about that?
40:25
I think it's so,
40:25
yeah,
40:26
I think,
40:26
I mean,
40:27
I love that y'all do this podcast.
40:29
Like I a part,
40:30
a big part of my recovery was like,
40:33
I literally because I knew that my eating disorder was just so strong.
40:36
I was like,
40:36
I have to read every book out there on anything related to this topic.
40:40
And I list probably,
40:41
I don't know,
40:42
over 100 podcast episodes just to like,
40:45
remind myself like,
40:46
oh yeah,
40:47
there are people in this world that are on this journey.
40:49
Oh,
40:49
yeah.
40:49
There are people that are learning to not think in this way.
40:52
Oh Yeah.
40:52
Oh Wow,
40:53
that's cool that she can talk about her body in that way.
40:55
Like,
40:56
like really like supplementing my efforts to rewire my brain with podcasts.
41:02
And so this is great that you guys have this.
41:04
It's so awesome.
41:06
Oh,
41:06
it's nice to think that we're hoping to rewire someone's brain out there.
41:10
That's such a nice thought.
41:13
Well,
41:13
Emily,
41:14
thank you so much for coming on the show.
41:16
We're so grateful.
41:17
So much.
41:18
Wonderful information.
41:19
And you've uh demystified so many things about,
41:23
you know,
41:23
treatment with a dietician and help debunk so many myths.
41:27
So,
41:27
I appreciate you so much.
41:29
How can our audience find out more about you on Instagram?
41:34
You can follow me um at Emily um Murray,
41:37
Muray dot RD and then uh my website for my practice is just Murray Nutrition co.com.
41:45
I understand any last like nugget that you wanna leave with our listeners today?
41:52
Oh,
41:52
man,
41:52
I always struggle with these.
41:54
Um Yeah,
41:56
I mean,
41:56
if someone has listened this far,
41:58
I would just say thank you.
42:00
Thank you so much.
42:01
You are so awesome.
42:02
Um Yeah,
42:03
and I think that one of the tactics that eating is shorter so often use is to tell people like,
42:09
uh just like that they're not gonna get better,
42:12
you know,
42:12
like you're not gonna get better,
42:13
you're too far gone,
42:14
you're not progressing fast enough,
42:15
whatever.
42:16
Like those have been a lot of my conversations recently with clients and I just wanna be like,
42:20
hey,
42:21
you know what if you're taking steps towards your recovery,
42:26
that is,
42:27
that is progress,
42:28
you're not gonna do it all in one day,
42:29
you just have to focus on today and what you can do right here right now and wait for some of the rest of it to fall into place.
42:36
So keep at it,
42:37
keep on the journey and it is worth it and it will always be worth it.
42:45
Thank you for listening with us today on All Bodies,
42:48
all Foods presented by the Renfrew Center for Eating Disorders.
42:52
We're looking forward to you joining us next time as we continue these conversations.