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.

Denise Kahm