Dr. Dusty Narducci, M.D. is a certified eating disorder specialist providing compassionate, personalized, medical, and mental health care for individuals with eating disorders, ADHD, PTSD, and other mental illnesses. She is Board Certified in both Family Practice and Sports Medicine. She has extensive training & experience working with athletes of all ages, sports, and levels as well as other populations with mental illness. Dr. Dusty believes in nourishing the mind, body, and soul in order to achieve one’s full potential. She is LGBTQIA(+)-friendly, and provides compassionate care to all of her patients. I am so pleased to feature Dr. Dusty on the Merrit Elizabeth Recovery Blog!

You have a unique medical background which brings a special professional perspective to treating eating disorders. As a fellowship-trained sports medicine physician with expertise in neurotrauma and a certified eating disorder specialist with several additional mental health treatment certifications, you have the capability of diagnosing and treating physical and mental illnesses. Generally speaking, the primary care physician tends to lead only the medical management in the treatment of eating disorders but you offer much more. Will you please discuss how your background in sports medicine now informs you in treating all patients with eating disorders? 

I have always been passionate about women’s health in sports medicine, and after working in my first professional role for about 6 years, I realized that there was a significant need in the field. That’s when I made the decision to start my own practice focused on eating disorders and mental health. I believe that the eating disorder community needs a voice, and my experiences working with athletes have shown me that many individuals go overlooked due to the culture that has developed in sports. Society often accepts and encourages strict diets, weight loss, and obsessive behavior when it comes to athletes and their bodies. I find this troubling, and it’s one of the reasons I have reservations about certain terms used in sports medicine, such as RED-S (Relative Energy Deficiency in Sport) and female athlete triad.

In some cases, the terms we use in sports medicine almost provide validation for unhealthy eating behaviors, inadvertently promoting an environment where athletes with eating disorders may feel justified. This deeply troubles me, and it’s an aspect of medicine that I am actively seeking to change. I firmly believe that it’s crucial for athletes with eating disorders to have a voice and feel comfortable reaching out for help. Given the shameful stigma surrounding this condition, it’s imperative that I advocate on their behalf to ensure they receive the support they need. By creating a safe and judgment-free space, I aim to empower athletes to open up about their concerns and provide them with the care and understanding they deserve.

I have personally witnessed and experienced the struggles that athletes face when it comes to eating disorders. Over the span of 6 years, I have seen individuals from all genders come forward, seeking understanding and help for their unique situation as athletes. This eye-opening experience led me to shift my career focus towards mental health and specifically addressing eating disorders within the field of sports medicine. I have observed numerous bone injuries, such as stress fractures and ligament/tendon issues, often directly linked to malnutrition/eating disorders. By delving deeper into this aspect, I aim to provide comprehensive care that addresses both physical and mental well-being, helping athletes avoid these detrimental consequences and reach peak performance.

One focus that stood out to me in my practice is the observation of a slow heart rate in athletes. While it may often be attributed to having “an athlete’s heart,” I have come to recognize that in the case of eating disorders, this slowed heart rate is actually a compensatory response due to malnutrition. This ability to discern the distinction has distinguished me from my colleagues, allowing me to provide uniquely targeted care in the realm of eating disorders and sports medicine.

During my time working at an academic concussion center, I  realized how concussions were correlated with eating disorders. I think it just brings up a lot of trauma and past stuff, and there are changes in the brain that then affect appetite. 

 In my experience, I have noticed a significant correlation between injury and the development of disordered eating or orthorexic behaviors among athletes. It is not uncommon for athletes to reduce their food intake when they are unable to engage in strenuous physical activity due to injury. This tendency can swiftly progress into a full-blown eating disorder. This aspect is particularly prevalent in the college athlete culture, where one teammate’s decision to embark on a diet can influence others to do the same, leading to distorted beliefs about certain foods being “bad” or detrimental to their performance.

By starting my own practice, I have the opportunity to address these issues and provide much-needed support for athletes struggling with eating disorders and mental health concerns. I’m excited to make a difference in this field and ensure that all athletes receive the comprehensive care they deserve

You and I both have lived experience with eating disorders that eventually pushed us to help others achieve full recovery. We often do not hear physicians admit to personal experience with eating disorders or any mental illnesses. How do you leverage your personal lived experience to empower your patients and why do you feel this is important?

Oh, this question, it literally brought tears to my eyes. I wish more people that I’ve talked to or have interviewed me would ask that. I don’t know if they’re afraid, but it is such a critical question. 

I really do think I’m great at what I do because of my personal lived experience. 

Having personally experienced it, I can attest to the complexity and misconceptions surrounding eating disorders. It’s a journey that only those who have lived through it can truly comprehend. Surprisingly, I have encountered high-functioning individuals from various professions and educational backgrounds in my clinic—these incredible, compassionate humans who excel in their respective fields. It’s fascinating to see how they can achieve outstanding academic results or professional success, while simultaneously struggling to nourish themselves or allow themselves adequate rest. Reflecting on my own journey, I am amazed at how I managed to overcome those challenges, with all the ups and downs involved, and reach a point of growth and recovery.

I will be totally honest. I was so ashamed in the beginning. I was told that if I ever said anything, I would lose credibility as a doctor. Again, that’s why I just love this question so much. It’s just so heartfelt to me. I kept my secret even after recovery for so long, because I was like, “Oh, if they found out now, they’re going to think that I’m going to go back there.”

I remember the first time I shared my personal story with a patient, I said something like, “Hey, I’ve been there. I get it.” And I remember her looking at me and being like, “No one’s ever understood me this way. Thank you for sharing.” Then I shared with the next patient, and then the next one, and then the next one. And then all of a sudden, I had a website stating ” I survived it. Studied It and Am Here to Help You Through It”. I wasn’t scared anymore. And honestly, my colleagues either don’t say anything, talked about in passing, or my courage is celebrated  

I understand from an athlete level, losing scholarships because of an eating disorder- and all the injuries. Also all the crap that’s happening to my body now because of how mean I was to it. I don’t want anyone to suffer the way I do now because I didn’t have support. So I’m blessed that I went through what I went through as much as it truly sucked. I would do it all over again just because that allows me to be that good at what I do. 

Patients with eating disorders often have co-occurring mood disorders like anxiety, depression, and OCD. What are some of the unique psychological therapies that you find most useful?

Neurofeedback is so cool.  It can alter the neuroplasticity of the brain and rewires things in a sense. We can look at the brain in a functional capacity, like what is the amygdala doing? How is the hippocampus functioning? Or the prefrontal cortex? All those different aspects of the brain, that then result in certain types of behaviors or thoughts or clinical diagnoses like OCD, ADHD, anxiety, and depression. The things that I see in my patients with eating disorders, as well as concussions, etc.  Neurofeedback can help calm the brain so people can find more benefit in therapy such as EMDR and ART for trauma. 

 I take it to another level by adding in genetic and neurotransmitter testing, to create a sort of personalized cocktail when prescribing medications. This science isn’t 100 percent accurate, but I think if you use it in the right context, it’s okay.

There are certain therapies like trauma therapy, which can be super helpful for PTSD, ro-DBT for the more over controlled client. There are a lot of lifestyle things for ADHD as well. 

I can’t wait for psychedelics to be legal. I think that will be game changer for the treatment of eating disorders. These substances when in the right hands allow patients to get a lot of work done, psychologically, quickly. Sadly, we’re not there yet, but my dream will come true and I’ll be sitting there waiting at the front door when it is.

Its important to mention, no treatment is the ‘right’ treatment and it takes a village, you need a group of expert clinicians that are willing to collaborate to help such a complex condition. 

Do you believe that medications are always necessary and if so, why and for how long?

When we’re malnourished, our bodies don’t make enough neurotransmitters–serotonin, norepinephrine, all of those. So the medications we have in clinical medicine or psychotropics, (we call it for depression and anxiety, all of that.) They don’t give you those neurotransmitters, they increase the effect of the ones we already have. So that’s why a lot of the studies show that these medicines are not helping eating disorders.  There’s a purpose and I’ll get to that for sure, but I don’t think it’s the end all be all.  

And then my theory, and, again, this is my personal opinion, medicine helps during the recovery process, during nutritional restoration, which is quite traumatic for a lot of people. But then the goal is to get them off because I want them functioning in the real world in their real state to understand their mind, body, and soul. And I don’t think being on six or seven medicines means that you’re in a great place. I think that’s a great start and you’re safe. But what’s the next step? That’s my goal when I see my clients. I don’t just stop at “Okay. Your behaviors are gone because I put you on medications.”

I do use medications a lot for the metabolic complications of eating disorders. For example, spironolactone. It aids in the low potassium levels that can occur with excessive purging.   It could save a life until the patient recovers. 

That medicine also can help with after somebody’s been self induced vomiting for a long time.  

Can you clarify what swells?

The whole body swells, everything, their face, legs, abdomen and arms. The response often leads to relapse because when you start purging again, that goes away.

I also use medication to help with POTS-postural orthostatic tachycardia syndrome, Mast cell activation syndrome, and SIBO just to name a few.

As an eating disorder recovery coach, I teach mindfulness practices to all of my clients to increase self-awareness and regulate emotions. How do you incorporate mindfulness-based stress reduction with your clients and why do you believe MBSR is important in helping them to achieve full recovery?

Oh, MBSR, I just love it. I use it every day of my life. Taking the time to be mindful, meditate, or just relax is practicing self-love. It’s allows time to just reflect and transcend the suffering that we are all going to have in life.

It do use MBSR in clinical practice but its not my first go to. When someone is in a traumatic place, or they’re so ashamed, or they’re so physically unstable, to ask them to do those types of practices is really hard. Sometimes it can backfire as they feel almost like a failure. So I’m very strategic about when I push it and when I’m implementing it.  

You are also a trauma-informed clinician. Please describe why a trauma-informed approach in the medical and mental health setting is so important.

So this is really where I wanted to set the bar. I had severe PTSD, a very, very tough childhood, and adulthood. And I think eating disorder recovery and treatment in itself can be traumatic.

Cognitive behavioral therapy for me was successful only to a certain point.  We use the term SEEDS aka Severe And Enduring Eating Disorders, but I always ask maybe there’s just something deeper going on and they haven’t had the correct treatment. We focus on the symptoms of not eating or over-exercising, rather than why is someone doing these things. Why do they feel like they need this in their life? What did they learn as a child or how are were they treated that makes this lack of self kindness acceptable to them? Was there neglect, bullying, abuse, rape? Most are using an eating disorder as a coping skill to hide the emotions of all this terrible stuff that they went through.

If you were never taught safe coping skills, eating disorders seem like a great way to cope. It can kill you, but it also helps you in a sense. I recently wrote a blog about that-Friend, Enemy, or Both? Understanding How an Eating Disorder Helps, Can Move You Closer to Recovery 

My eating disorder helped me at a time in my life when I needed it, and it it shouldn’t be that way, but I didn’t know any other way. Treating my trauma allowed me to live through life hardships in a healthier way and the eating disorder behaviors/thoughts sort of fell off my radar.

I even saw that using the trauma therapy would help people if I needed to recommend a higher level of care because they were so traumatized by past experience.  I was able to calm them from these past experiences, using EMDR or ART, then they could go into treatment and be okay and actually be successful. 

 There are a lot of misconceptions about it, that people are going to decompensate or must have to be a certain BMI to be successful with trauma therapy. I think the future of eating disorder treatment will always include trauma therapy to some capacity or at least I hope it does. 

If there is one thing you could tell those suffering with an eating disorder and those who love them, what would it be?

I am sending all loved ones of people living with eating disorders my empathy because its a condition that effects not only the individual living with the condition by those around them. 

Please don’t assume you understand why someone has an eating disorder. It’s very invalidating when somebody says ‘just to eat’, or ‘you’ll get through it’, or ‘you’ll grow out of it or ‘it’s because you want to be in control’. It’s so much deeper than that. It is a metabolic physiological interweave and you have to stop the motivation to continue to use the eating disorder as a tool. 

Also, I would tell loved ones, please don’t fixate on trying to understand and just love the individual and support them. Understanding, people think they need to do to show love, and that’s not always true. Sometimes  saying “I don’t understand, and I don’t need to, I just want you to know that I’m here for you” is perfect. These beautiful, simple words, can save a life.

The clients I have are the kind, loving, compassionate, successful people. They are these earth angels that don’t know how to handle their empathetic energy or how to handle suffering so they hurt themselves. And there’s nothing to feel ashamed of.

Each of us possesses a unique beauty that extends far beyond our physical appearance. Our souls and minds are incredibly remarkable. However, it is crucial to instill in others the understanding and appreciation of this remarkable inner essence. By empowering individuals to advocate for their needs and access the medical care they deserve, we can ensure their well-being and foster a society that embraces and celebrates every individual’s inherent brilliance.

Many conventional approaches to treating eating disorders often fall short in achieving long-lasting results. Fortunately, there are professionals available who grasp the complexities of this condition and can provide effective assistance. All it takes is readiness and willingness on the part of individuals to embark on their unique journey towards recovery. Recognizing that each person experiences their own defining moment, we are here to guide and support them towards a transformative path of healing.

Do you have more questions for Dr. Dusty? Reach out to me here!

Check out Dr. Dusty’s website:

https://www.docdusty.com

Book an appointment with Dr. Dusty:

https://provider.kareo.com/dusty-narducci#?view=booking

Interested in virtual eating disorder recovery coaching with Merrit Elizabeth? Schedule a free 25-minute consultation call here!

Merrit Elizabeth

Merrit Elizabeth is an Eating Disorder Recovery Coach certified by The Carolyn Costin Institute. She holds a master’s degree in Health Promotion Management and has years of experience working with women with eating disorders.