Congratulations Elaina!

We want to congratulate our nutritionist, Elaina, on just getting her CEDRD, which is the highest possible credentialing for Eating Disorder Treatment! This is no small feat: it takes considerable training, hours of experience and coursework, as well as rigorous exams. Very very few RDs have this credential. Well done!

 

Here is a paragraph, culled from IAEDP’s website, about the credentialing:

 

Certified Eating Disorder Registered Dietitian (CEDRD) is a credential maintained by the International Association of Eating Disorder Professionals (IAEDP). This certification aims to establish expertise in the field by requiring dietitians with the CEDRD credential to meet rigorous educational and skill requirements, accumulate a minimum number of hours of qualifying work experience and commit to stay current with all new developments in the field of eating disorders. Completion of this credential provides the certified RD with the skills to address all issues related to food and nutrition, physiology and behavior change associated with eating disorders. A CEDRD is uniquely qualified to provide medical nutrition therapy across the full spectrum of disordered eating and at all levels of eating disorder care.

If you want to learn more about the certification, you can find info here: http://www.iaedp.com/certification-overview/

 

an interview with our founder, Annika Kahm and her colleague Carolyn Hodges Chaffee

Gürze just published an interview with Annika Kahm (our founder) and Carolyn Hodges Chaffee. The interview was motivated by the publication of their book, Measuring Health From The Inside. Here are a few excerpts from the interview:

What are some of the complications that affect the brain’s neurotransmitters as a result of compulsive exercise?

Exercise does affect the neurotransmitters in the brain. Exercise in moderation or making sure the body is adequately fueled for the level of activity can have a very positive effect on the neurotransmitter levels. However, when exercise becomes compulsive and the body is not adequately nourished it can have a negative effect on the body.

Exercising at a high level and restricting the intake for prolonged periods of time causes an increase in cortisol. Elevated levels of cortisol for extended periods can lead to cellular death.

There is also a feedback mechanism that occurs with compulsive exercise that increases the risk of addiction. When an individual exercises, the brain gets a burst of dopamine in the reward/pleasure center of the brain. For those individuals, the more they exercise the more they feel compelled to exercise.   As those individuals continue to exercise it becomes compulsive, unable to take a day off, having it interfere with their daily living, and doing exercise that for them doesn’t count.

From an eating disorder perspective, what are the different ways individuals develop malnutrition or become nutritionally depleted?

Malnutrition can occur in many different ways; when the body is underfed for an extended period of time (anorexia, orthorexia), when it operates at a calorie deficit because of a high level of energy expenditure (compulsive exercise), or when the body is unable to absorb nutrients (bulimia).  The body is designed to tolerate brief periods of malnutrition, but how well depends on the body’s nutritional status and how much body fat the body is able to mobilize to endure the starvation.

When an individual restricts their intake, there are mechanisms that occur in the body that lead to a decrease in hunger.  The metabolic rate will gradually decrease, causing fewer hunger cues.  As weight is lost, the gut will eventually develop gastroparesis which slows the emptying of the gut.  This results in bloating and discomfort when eating which makes it more comfortable to not eat (restrict) or get rid of what was eaten (purge).  Regardless of the behavior, the body will eventually become malnourished.

 

When working with clients who are diagnosed with eating disorders, what do you find are the merits of using Metabolic Testing (MT) and Body Composition Analysis (BCA)?

It’s invaluable, especially since many clients don’t think they have an eating disorder unless they are seriously underweight or actively purging.  If they have been diagnosed with an eating disorder, but are in denial, the MT and BCA give empirical evidence to the malnutrition it has caused for their body.  A low metabolic rate (hypometabolic), using excessive protein stores to meet their caloric needs (catabolic), low phase angle (indicative of poor cell integrity), and body fat well below normal ranges for age, sex, and height are all examples of information gained by the testing.

Today’s diagnostic criteria miss some seriously disordered patients because blood work is usually within normal limits, even in very sick individuals.  Scale weight is not an indicator of an individual’s fat, lean or health.  This is why we fail this patient population.  A patient can be normal weight or overweight and still have an eating disorder and weight restoration is only part of recovery.

Also, we do BCA at every visit, giving them feedback of how the body responds to their food intake. We let the patient know if they are eating enough to allow for not only daily needs, but also for repair and healing of their malnourished body.  This way they are actively involved in the recovery process.

One of the goals during hospitalization is to weight restore the patient.  Without the MT and BCA it is very difficult to determine, as well as convince the patient that is weight restored, that they are still malnourished and may need to gain more weight.  If an individual is not fully nutritionally recovered, it increases the likelihood and risk of relapse.  When the individual sees their actual test results, it is easier for them to follow treatment recommendations.

The full interview can be found here.

Evidence That Our Method Works: One of Our Patients

Maria, a 17-year-old girl, was five feet tall and weighed 95 pounds. She was on the varsity crew team and practiced two hours every day for nationals. She had her first period when she was 14, and over the past three years she had had a total of 10 periods. She was eating 1400 calories a day and wanted to weigh 90 pounds. She weighed herself at least twice a day. If the scale was up one day, she made sure it was down the following day. Two years earlier, she had a stress fracture, but no bone density test had been done. Metabolic Testing showed she was severely hypometabolic, burning only 386 calories a day and therefore using her own lean tissue (organs, muscle, and bone) for fuel. Other medical tests revealed that she was anemic, deficient in vitamin D, and had osteoporosis (bone loss). 

Initially, she reluctantly agreed to eat 2,000 calories a day. She was asked to stop exercising to correct the Relative Energy Deficit in Sports. After two months she got her period, and after four months of eating close to 2,200 calories a day, she reached 100 pounds. This frightened her. Her Metabolic Test and Body Composition Analysis showed major improvements, but her metabolism was still not corrected. She felt that she should be rewarded, and so her parents allowed and encouraged her to start exercising again. Three weeks later she was re-tested and her metabolic rate had plummeted from 1,000 calories to 437 calories a day. She had lost lean mass and her fat weight had increased. She had returned to being very hypometabolic and catabolic. It's as if her body was saying, "Don’t mess with me...I'll show you, you are hurting yourself!"

Maria and her parents were wrong in thinking that just because she had reached 100 pounds and had gotten her period that she was recovered. It took another three months, eating 2,500 calories per day, for her body to recover and to have a normal metabolic rate with a healthy amount of lean mass. She ended up weighing just over 100 pounds. Her percentage of body fat was lower than her first visit. She admitted that she had been in denial and would have continued being in denial if it wasn't for the Metabolic Testing and the Body Composition Analysis. 

 

The Data that Dieting Doesn't Work

The Data that Dieting Doesn't Work

Does dieting work? Well, it depends on how success is measured. And what the medical and diet industry mean by success is not what ordinary people mean. Let me explain.[1]

 

In the 1940s, success was measured by getting people to a “normal” BMI (an unscientific height/weight ratio),[2] but diets didn’t help most people get there. So in the 1950s they simply changed the measure of success to losing 40lbs, but 95% of people couldn’t do that.[3] As a result, in the next decades, they simply lowered the bar again to 20lbs.[4] But 20lbs is quite different for someone who is 150lbs than someone who is 300lbs, so in the 1970s, they changed it, yet again, to 10% of one’s starting weight. But since 80% failed at this,[5] in 1995, the Institute of Medicine lowered it to 5%.[6] This is obviously nonsense.

Weight MANAGEMENT

The Pitfalls Of The Usual Approach

The optimal weight for each person differs depending on sex, age, genetics, environment, lifestyle, and other variables. Because of today’s diet, fashion and media industry, as well as doctor’s recommendations (based on old fashioned height/weight charts created by insurance companies in the 40s and 50s), most people’s ideal weight goals are set too low. Too many people would like to have bodies like Gisele and Tom Brady and believe that with enough grit and willpower such transformation is possible. It is not. However, even those with far more modest goals routinely fail, as is shown by the well-known statistic that more than 95% of dieters gain their weight back.