Steve Martorano 
The Behavioral Corner is produced in partnership withRetreat Behavioral Health -- where healing happens.
 
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 discuss how we live today, the choices we make, what we do, and how they affect our health and well-being. So you're on the corner, the Behavioral Corner. Please hang around for a while

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Steve Martorano 
Hi, everybody. Welcome to the Behavioral Corner. It's me, Steve Martorano. New Year, same Corner. Same, Steve. Before we get started, if you're just joining us, this is a podcast about everything because that's what affects our behavioral health in a nutshell, everything. It's all made possible by our underwriting partners Retreat Behavioral Health. You'll hear more about them a little bit later. With our guests. I want to welcome her right away. A good friend of the program, and a frequent contributor, Dr. Rhona Epstein. Hi, Rhona, good to see you again.

Dr. Rhona Epstein 
Hey, Steve, thanks for having me.

Steve Martorano 
Always a pleasure. We reached out to Dr. Epstein at this time of the year by no coincidence. first of the year, we are inundated with the television commercials and the messaging and the social media, it's time to lose weight. It's time to get on this program. Time to get on that program. So we all know about that. Dr. Epstein's specialty is food disorders. She is a clinical psychologist. She's been doing this for years. And she treats various food disorders. She does so from what I believe is the first time I ever heard it was from her and that is from the addiction model. The first time I interviewed Dr. Epstein I became addicted to food. How can you be addicted to food? Turns out it's easy. Turns out it's very easy. And that's the way she treats it from that unique perspective. The way you're dealing with here is not a moral failure or a lack of willpower, but a problem not unlike cigarette addiction or opioid addiction. So that pretty much sums it up. Doc?

Dr. Rhona Epstein 
Exactly.

Steve Martorano 
Yeah. I mean, the first time so you know, for people who may be hearing about food addiction for the first time. Can you briefly explain? I mean, you mean literally an addiction, right?

Dr. Rhona Epstein 
Well, yeah, yeah. I mean, obviously, some people would disagree with the concept. And it's still controversial as far as the scientific matter. I mean, there's the science that says, when you look at a person's brain, that it looks just like other substances like alcohol and other substances of abuse, that actually, there's some amazing scientific evidence that even it's even worse like that they say that sugar is eight times more addictive than cocaine. And so the way the brain lights up, it's like a pinball game in there within the pleasure centers of the brain, when people are eating sweets, that, you know, they're getting a hit. And actually, you know, in rat studies, the rats would pick sugar over cocaine. They're addicted already. So yeah, I mean, there are addictive myths there, the behaviors the same, if you look, side by side at the DSM of Addictive Disorders, to people who struggle with addictive eating, it's the same symptoms, the same criteria they fix. So...

Steve Martorano 
One of the most obvious ways it fits or mirrors addiction, we talk about addictions in general, whether they be processed addictions, or physical addictions, as becoming a problem, when they obviously begin to interfere with your life, in fact, threaten your life. And certainly we can, we can see where food in an addictive manner, can just make your life miserable. And so it's not hard to understand all that. I think you and I are not here to debate whether the sciences are adequate on that. There's certainly enough evidence to suggest that this is a good way maybe better to treat these problems as any other way. So let's talk a couple of things about what are some of the typical eating disorders that you treat.

Dr. Rhona Epstein 
Well, I particularly typically work with people who are overeaters, binge eaters, people who graze on food all day about obese compulsive overeaters. Bulimics. But you know, people who really are out of control with eating. I work sometimes with anorexics, but usually only if they are people who swing between starving and binging. I'm really there for the person who's out of control. That's really my forte.

Steve Martorano 
And when you mentioned anorexia and bulimia, we're not talking about again, minor disorders, they aren't life-threatening, but they can be life-threatening conditions. Is sugar the be-all and end-all of the problem? Is that the problem? Or are there other factors that contribute to disorders, mirroring addictions?

Dr. Rhona Epstein 
I think sugars, are the most problematic for people, I think it's the most addictive of the foods. But I don't think it's surely it's not the only I mean, there I meet people who, you know, they really get into trouble with savory foods with crunchy salty foods. I actually find it surprising that some of the people who are having the worst problems they really can take or leave the sweet it's not really their problem. And they're really hooked on large quantities of foods that may be I mean, I find it surprising myself, I have a history of, you know, sugar addiction. I mean, I was like a heroin addict with sugar...hardcore sugar. I was like, the, the, the cream in the donut like I went for the sweetness of the sweets, you know, the Oreos with double stuff, the, you know, Rocky Road ice cream. I mean, I would if it was super, ultra sweet. That's what I was going for. But I see people who, you know, they're eating a pound of steak at dinner, you know. And, you know...

Steve Martorano 
I remember your story, the first one of the first stories you told us about your struggles as a young woman, with these problems, and in addition to binging and sugar addiction, you were maniacal in working out, because you were worried about you know, I'm going to eat like this. You got to lose weight. So you're always working out and you told her an incredible story about how you would slave at the gym. And then on the way home stop at Dunkin Donuts for a dozen donuts. That was a typical move for you, right?

Dr. Rhona Epstein 
Yeah. Oh, yeah, totally.

Steve Martorano 
What do we know about this is a strange question. It's just a cursory what do we know about our tastebuds and how they impact this? We will some people just couldn't know they don't have that sweet tooth to integrate that way we have kind of colorful and sweet terms while he has a sweet tooth. Some people don't have that sweet tooth. So that's not a Is that a question of brain chemistry? Or where they're sensitive on their palate?

Dr. Rhona Epstein 
Yeah, well, probably is a brain must be because I you know, why does one person you know, get there, they get their hit? It's just like, I guess with alcohol and drugs. I mean, why is one person a heroin addict? Why is one person a cocaine addict? Why does a person like speed and another person likes it? You know, alcohol, we lose. I mean, we, you know, you gotta people, like all kinds of different kinds of ways to hit, right?

Steve Martorano 
I guess, choose your poison. Right? I guess. So let's, let's talk about, you know, we you've mentioned the kinds of people you treat the disorders that they have central to them, whether it be anorexia, bulimia, or grazing is, they are compelled to do this correct?

Dr. Rhona Epstein 
Well, that's the thing. I mean, you know, a sweet tooth, I mean, somebody can have a sweet tooth and be like, Oh, I like my sweets, I mean, that a normal person can have like, a, you know, a taste of a little sweet after dinner, and they and they're good to go, you know? They've satisfied, their craving for their little dessert, and they're, and they're good to go. But for somebody who is struggling with addictive behavior, there with their food it's a compulsion. It's, it's driving them, they're obsessed with it, they have to have it and then they have to have, it's like, well, they say, you know, it, one is never enough. And one is too many and 1000 is never enough. So you, you know, you, you start with the one and you think I'm just gonna have one but then you know that compulsion comes over you. And then you just, you know, what you meant to only have the one cookie, and then it's like, nine years later, and you're a slave to the cookies, and you can't stop and you want to kill yourself, because it's...

Steve Martorano 
It's characterized by that, but what you just described as it is a lack of control, impulse control, doesn't work. There is no stop sign. Right?

Dr. Rhona Epstein 
No hold button.

Steve Martorano 
You just go for it until you're either, you know, sick, or vomiting or something. When you treat these people, do you begin at that point? What psychologically or physically is going on in your life and your relationship to food that causes you not to stop after one donut? Is that how you begin?

Dr. Rhona Epstein 
Yeah, I mean, I think you have to help a person see that they have a problem, right? I mean, obviously, some people when they get to me, they found they searched the web looking for somebody who treats this problem. They're looking for help because they know they were on and you know? Usually, when we start talking, I start asking questions. Just see, like, you know, not everybody who has a problem with overeating has an addictiveness. If not, you know, sometimes it's an emotional problem. Sometimes people are eating because they're bored, or they're eating because they're stressed. Or they're just, it's a, it's like a coping strategy that if you can teach them a different coping strategy, they can learn that it's not the same as somebody who, since they were little, they've been hiding and sneaking and lying and, you know, compulsive I mean, there's a difference. So you have to assess a person to find out whether, you know, you need to be really treating it like an addiction, or, you know, more like an emotional, psychological problem. So, right. So, I mean, when I meet a person, I don't just jump in and start calling all food disorders, or addiction.

Steve Martorano 
When there is this notion of addiction model that seems to be presenting itself. One of the things in substance abuse treatment, they talk about identifying triggers that, you know, might cause you to go off the rails. Are there food triggers?

Dr. Rhona Epstein 
Absolutely. That's, um, my first book was called Food Triggers. It's the name of the book. But oh, yeah, I mean, I probably spend a lot of time helping people. Because that's such an important part of recovery is understanding the physical and emotional and spiritual triggers and being able to identify how to navigate it's sort of like, what are the landmines? What are the things so so there's food triggers that are like, you know, I mean, for me, it's sugar. And any processed foods are usually processed foods that oftentimes trigger people to eat white flour, or anything that's not real food is sometimes triggering, because the person needs to eat food, that's real, and have their body nourished. And if they're not properly nourished at their meals, then they're going to be triggered. So even dieting can be a trigger. You know, starving people are like now it's the beginning of the year, and everybody's on their diets. And they're hurrying up to lose weight because they have these shiny new weight loss programs. Restricting is a trigger. You know, people get up and I have people will say to me, I didn't eat breakfast today, and I'm feeling great about myself. And I'm like, yeah, how long is it gonna last? Before you are so hungry? You end up binging. So a trigger can be a food that is addictive, like, you know, foods or certain foods are made so that we won't be able to stop eating them. You know, those, once you crunchy things that we buy that are crackers that are made so that you can't resist eating the whole box. I mean, somebody thought that through real well. I mean, they were made, so you can't stop.

Steve Martorano 
Oh, my favorite example of that is whenever they take something that's fairly well-known. And you're right, it's usually a sugary kind of snack. And you've noticed in one size for many, many years, and then suddenly you find next to in the store a bag of the same thing only in bite-size proportions. And I always looked at that as "Oh, they just want you to grab handfuls of that stuff, because it looks smaller. So I can eat more than if it were a large-size thing." Yeah, there is a concerted effort to get us to eat in certain bad ways. You talked about processed food. In a nutshell, that's anything that's in plastic pretty much right. And anything that's wrapped up is processed. And, you know, let me give you a personal example, when several years back, I wanted to lose some weight. And I got caught up in the Atkins diet. And I read his book, and it seemed to make sense, but, and I lost some weight on it. But it was without a doubt one of the most difficult things I have ever tried to do got a fairly good amount of self-control. But I found cutting carbs out of my diet completely, almost impossible. And it was a really painful thing. And at some point, it occurred to me that firstly, you couldn't eat all the bacon in the world. They told you you could, but you can't. And I would find myself not so much hungry after I didn't. I wasn't sated, but craving that piece of bread. And I said, Wow, it looks to me like carbohydrates are craving is that true?

Dr. Rhona Epstein 
Well, so there's healthy carbs and then there's the carbs that are really unhealthy. So like it depends on what you're choosing for your carbs. So right so I think in the day that we're in 2024, there's a huge thing about cars I mean that you know, in, at our age, we've seen it, all right, we've gone through seasons where it was, you know, fat is bad. Now it's today, it's carbs, right? So all the Gurus out, there are scientifically proving that you should eat a high protein, high fat, low carb diet. That's what everybody's saying. Personally, I think that eating a balanced way of eating is the best thing, although I understand that the science behind this and people will lose weight, and everybody wants to lose weight. The problem about what you're just what you just said, and what I see in my practice, is that people will hurry up and lose their weight without the carbs. But is it sustainable? And my goal with people is to help them find something that is sustainable. And if you can't live on it, then you're just doing a short-term fix that's going to end you actually gaining weight in the end. So I think learning how to pick healthy, not the carbs that are like the white flour, processed carbs, but sweet potatoes, you know, those are carbs that are stuck to your ribs, you know, and they fill you and they're good for you. Brown rice is another you know, these are carbs eat some of these people who are stripping you of all carbohydrates, and they'll say don't eat any of those. But I think you need them. That fills you up, it gives you a little more feeling of fullness. And if you're trying to recover, you need to be full from your healthy food, so you're looking for junk food.

Steve Martorano 
Our guest is Dr. Rhona. Epstein deals as you can see with food and eating disorders. With this other thing about dieting, and you know, everybody's got a new plan. Dieting is really putting the cart before the horse, isn't it?

Dr. Rhona Epstein 
Well, dieting is what you know, what we all are looking for is the fast fix. And what we're doing is trying to fix the weight problem and not the eating problem.

Steve Martorano  
The reason that you're overweight, to begin with, correct?

Dr. Rhona Epstein 
Exactly, and that's what we're anxious about. And that's what we're upset about. And so that's a big part of what I get caught up with people because they really just want to lose weight, they don't want to change. But when if you going to stop having a roller-coaster relationship with food? People go on diets, they gain, they lose that game, they lose, and most people trapped in that end up in the end. Really, it's like gambling, you lose in the end by gaining weight, but you don't really lose weight that way. Because you know, you end up gaining weight after your diet. So you know, teaching a person about having a healthy relationship with food where you don't abuse it, and you're not trying to fix the addictive behavior by starving yourself into being a thin person, but then you can't sustain it. I mean, it's crazy. The roller coaster right? You're off. You're in. Your out. You know, it's crazy.

Steve Martorano 
Well, it's extremely extraordinary that there should be such a gigantic business in diet plans when there's every bit of evidence that yo-yo, dieting is a real thing. And everybody knows it's a real thing. And yet, I'm going to be the one who will keep the weight off. It just never works out that way.

Dr. Rhona Epstein 
Oh, they're brilliant with the magic cure thing. I mean, they're brilliant.

Steve Martorano 
We're gonna get to a magic cure thing. Just a moment. Before we do that a little bit more of your clients and who you see, there had been I think this has probably changed for a very long time, the notion that eating disorders were almost overwhelmingly problems for women, young women, and women of all ages. That changed. Do you treat both men and women?

Dr. Rhona Epstein 
I do. I do. Yeah, men struggle with all kinds of eating disorders. And I think it's a shame because I think what happens is that men think that, you know, it's a big deal for them to go into recovery. But you know, actually, Overeaters Anonymous has multiple OA meetings just for men a day. Men are meeting from all over the world, they have found recovery. So it's absolutely not just for women.

Steve Martorano 
I know that you mentioned in your, on your website, and in your practice in the books you've written about food addictions and eating disorders, that there is a spiritual component that people are to address if they're going to conquer something like this. That's certainly true for substance abuse sufferers as well, you certainly know that the Big Book talks about a greater power. And many people who scientists will tell you that these addictive behaviors are an effort to fill some hole that's there. I've spoken and spoken to so many people who have recovered from substance abuse. And they all say the same thing about why it started, they never felt they fit. They were always out of place. Something was missing. You deal with that with your clients and your patients all the time, right?

Dr. Rhona Epstein 
Absolutely. Well, for me, I mean, developing a spiritual life was like the solution. It's like the missing part. It was like, you know, you're going along in your life, and you're, you know, foods filling a hole, but it's not I mean, doesn't satisfy. So that's the name of my books. And I have several books that are we that's the program I run, called Satisfied. But it's like, and that's sort of the whole point satisfied with your food satisfied, spiritually, emotionally satisfied, right? There's like, that's what we need is to be filled. Right? So being filled spiritually, is...that's the solution. It's like, there's an emptiness and we need to fill it.

Steve Martorano 
You know, what's more insidious about a food addiction, addiction, as opposed to a cigarette or tobacco or substance abuse, or they're deadly and devastating as well. But in that emptiness, that lack of meaning in your life, when you try to fill it with something like heroin, I mean, you can see how ridiculous that is, and what the end result will be. On the other hand, if you feel, you know, less than worthwhile, filling it with food doesn't seem to be a danger, right? Because we all eat. So if I'm feeling bad, maybe I'll feel better if I have two pieces of cake. There's something in other words, what I say is food is so common, and we need it. It can mask those things, the loss of spirituality.

Dr. Rhona Epstein 
It can't, it can't except for really just like all of them, it just blocks your spiritual it's like if there's a pipeline between us and God, then then the food ends up blocking the pipeline. There's no you don't, you can't experience your life fully because now foods are sort of clogging the pipeline.

Steve Martorano 
That's not the food in the world.

Dr. Rhona Epstein 
Yeah. Not enough food in the world.

Steve Martorano 
Not enough food in the world. Yeah, it's always great to talk to you because this is such a fresh and some would say some say while spirituality, what's got to it that stopped eating, you know, now we've gotten into a new realm...I think it's a new realm anyway. And I wanted to kind of sum up, it's a big topic, that's why we have Dr. Epstein with us very frequently because there are so many things to talk about. I'd like to get your impression on this new class of weight loss drugs that have swept the entire world, I guess, Ozempic is the am I pronouncing that right? Ozempic is the most notable of them but there are others. And if I understand that, and I haven't read enough about it, the central premise here is that these drugs eliminate the craving for food. Is that what's going on with these drugs?

Dr. Rhona Epstein 
Well, that's what it should do. But with with the truth, your data, like that doesn't really work. I mean, you know, it's just like the medications that they use to try to treat alcoholism. I'm how's that go? Well,

Steve Martorano 
Well but you know, it's interesting, that you mentioned that because for the longest time, every reputable clinician or organization that was treating substance abuse, operated on the abstinence model, okay? Here's how you stop this stuff. Don't do it. Just stop, don't do it. But they slowly had to recognize that there were medicines that could be used to help the process, along with everything else. So it's called, it's called MAT. I know you're aware of MAT. So when we get to this issue of food disorders, and we've now we've got drugs that they say can treat it. Do you believe that they ultimately will be beneficial in a broader program?

Dr. Rhona Epstein 
I think it's the same thing. And I used to be a drug and alcohol counselor, that's what I did. You know, the bottom line is people are abusing their addictive substances for a multitude of reasons. I just finished a group before I got on here. And you know, a person is talking about feeling very overwhelmed with shame over something. And this person is trying to be in recovery but ends up eating because of shame, right? Not an uncommon story, feeling bad about herself because something happened and you know? Medication doesn't stop the shame. So medication doesn't stop a person from hating themselves. It doesn't stop them from feeling lonely and bored. So you can give the person medicine and it might reduce their cravings. And it might help. So if just like the medications that you use for substance abuse to reduce cravings, it could help. But if the person doesn't have a transformation, like in the 12 steps, there's a transformation that experiences they have a healing of their soul, and a healing of their spirit in their mind, and they have a transformation. But if you're just going to rely on medication, a real food addict, it's not going to be enough. And I'm seeing that with my clients. I see people, who're on the medication, and they're still binging their brains out. The medication may have helped them lose 10 pounds, but they're still sneaking and hiding because they have other reasons why they can't stop.

Steve Martorano 
Yeah, well, that's why your model is so at this moment with this new class of drugs, is a great moment to take a look at how very close food abuse can be an addiction model, in that you what you just said, it's perfectly obvious. You're right, suboxone will cut down the craving. But if it is not administered in conjunction with talk, therapies, counseling, and all of that, it's not going to do anything for you. The same is true with Ozempic, you know, but it's dieting, Rhona you know, everybody's looking for that magic pill, and then all the problems will go away, I think people are going to be very disappointed. It's interesting, too, that it works on some part of the brain that stops cravings for other things, too. So they really don't know much about I've read that. It also can cure smoking addiction, which it has shown some help.

Dr. Rhona Epstein 
You know, look, I'm not a medical doctor, but I, you know, I listened to different people who I trust. And, you know, I have recently heard some of the downsides about long-term use and side effects and the fact that people have to stay on it. And once they would go off of it, they're going to gain their weight back. So again, if there's no transformation, and you're relying on medication, I mean, ultimately, the person needs to change. Just one of my clients the other day who's on the medication, I said, "Look, you are having a reduction in hunger right now, let's use this as your opportunity to really work on your recovery work, get involved in your support system, really do the 12 steps, like go all the way go all in, get some stuff together, while your cravings are lower, while your hunger is a little reduced. And let's use it as a tool. You know, if you're going to be on the medicine, let's take advantage of it." So she so if she does the transformation, then, you know, we can talk about that she might not need the medicine later, right?

Steve Martorano 
Yeah, yeah, yeah. Yeah. Cuz she's gotten to the root of the problem. Let me finally ask you this, and we'll let you go. Because I know you're busy. In substance abuse, they talk about our alcoholism anyway, there's no cure, you're just going to manage this disorder. With regard to eating disorders that you treat, and the fashion in which you treat them? Do you look to cure the disorder, or to help the person managing?

Dr. Rhona Epstein 
Well, I guess it depends on your I mean, semantics, really, I mean, even the AA Big Book tells you that you can recover as long as it says that you have a daily reprieve that's based on your spiritual condition. So the the AA Big Book promises that you will no longer be fighting. That you will recoil from it as from a hot flame, that you that you can actually experience freedom and that you won't be tempted. I believe in that that's a possibility. I mean, I think that once people understand, you know, like for myself, I have 40 years of recovery experience. I celebrated 40 years of recovery. Honestly, I'm not I'm not bragging and bragging on the program that my recovery is based on, I try my best to, you know, practice what I preach, right? So I practice what I preach. I have to live well. I have to work on my insights stuff, my relationships, my spiritual life, and my health but I also understand some things. I cannot eat one cookie. I know that one cookie is like sticking a needle in my arm. I can have one. I cannot even consider or contemplate the idea of it. It's not even it's off the table. As long as I don't pick up the foods that are off limits to me, and I follow my routine boundaries with food. And I try to maintain a relatively sane life as much as I possibly can, which of course, that in itself is a challenge in this crazy world. But you know, dealing with all the things, the stresses, you know, whenever I don't fight temptation, I believe if I did start to play with it. So I believe I see people every day who experienced this, what they call neutrality, you know, it's it. That's what from the big book, The AA Big Book, this is 12-step language, right? Neutrality is when you can sit in the room with it, and it doesn't call you.

Steve Martorano 
Yeah, you know, and you just, you just said it, when talking about curing or just managing a disorder. At some point, you're splitting hairs here, because you're doing both things, as a matter of fact, you are, as you say, living with it. That means that means sort of managing the situation. But for all practical purposes, as long as you've managed the situation, you're cured. So it's, it's very helpful to, to hear that. Rhona Epstein, you're the best on this topic. I mean, you just are, it's just so fascinating to hear the way you've approached this. You have a wonderful website, which I've been looking at. It's filled with lots of information, the titles of all your books. How many books have you published, now?

Dr. Rhona Epstein 
I have four, and I'm working on one right now that'll probably come out, we'll come out and 2024. The next one is going to be on. We'll have a food plan guide and some recipes and things like that. But yeah, I got...

Steve Martorano 
Oh, I'd love to do a recipe show we're going to have to have you back on. We'll have a link to Dr. Epstein's site and there's a phone number that you can call if you're in our area of the world, which is the Delaware Valley. She's a phone call away. You are accepting patients?

Dr. Rhona Epstein 
Well, yeah, they can find, you know, yeah, they can find that information on my website or just, you know, call me.

Steve Martorano  
Well, good luck with the new book. Happy New Year. And please, when it comes out, you know, get your PR people to alert us. We'd love to have you back. As always.

Dr. Rhona Epstein 
Thank you, it's been a blessing. I love being able to hang out with you on the Behavioral Corner.

Steve Martorano 
We go back a while, right? We go way back. Anyway, thank you all as well. Welcome to the podcast in the new year. It will be the beginning of our fifth as a podcast. You know the deal like us subscribe to us do that whole thing. We appreciate it Behavioral Corner. See you next time. Bye bye.

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