FREQUENTLY ASKED QUESTIONS
Q1
Do you accept insurance?
In Vermont we are in network with Medicaid, Blue Cross Blue Shield of Vermont, MVP and Cigna.
We do not accept insurance at our other locations.
Q2
Are Metabolic Testing and Body Composition painful tests?
No, both Metabolic Testing and Body Composition Analysis are non-invasive tests, so you don’t have to worry about being poked by any needles at our office. During the Metabolic testing procedure, the patient sits in a reclining chair under a lightweight canopy hood and essentially relaxes for about 20 minutes. For Body Composition Analysis, the patient is required to lie down and have electrodes attached to the wrist and foot to pass a small and painless electrical current through the body.
Q3
How long will it take my metabolism to improve if I am malnourished?
Your metabolism begins to improve as soon as you start to adjust your caloric intake. The length of time depends on how severely hypometabolic you are and how much repair the body needs to do and if you are able to follow the treatment recommendations. With total compliance, we have seen metabolic rates corrected in six to eight weeks.
Q4
Doesn't exercise improve my metabolism?
Exercise may actually slow your metabolism if your body is not getting enough nourishment. The reason this occurs is because your body is trying to conserve energy stores in the body. Exercising when the body is trying to repair itself uses vital energy stores.
If I eat more calories than my body is burning, won't I gain a lot of fat weight?
When the body is repairing, it is using the extra calories to restore cellular integrity. The body will gradually weight restore both lean and fat weight. There may be an initial weight gain but as the metabolic rate improves this stabilizes.
Q5
What is the difference between Body Composition Analysis and Body Mass Index (BMI)?
BMI is based on height and weight but does not take into account the body composition. BCA measures body fat, lean dry mass (muscle), total body water, intracellular water, and phase angle (which is the measurement based on the total body resistance and reactance). Often, during annual physicals the focus is on a healthy BMI, but this focus is too narrow and often misleading.
Q6
How can I be malnourished if my body weight is normal?
This is also an issue of how BMI is a poor indication of total health. Attaining a normal weight is not an indication that your body is burning a normal amount of calories and not breaking down it's own protein stores. It is possible to eat enough to gain weight but not improve your metabolic rate. Our tests can properly assess your body's total health and whether or not you are nourishing your body properly.
Q7
Q8
What are the goals by which you measure success?
Our goal is for you to reach your optimal health. Because we can measure your health from the inside with Metabolic Testing and Body Composition Analysis, we want your numbers to be within normal ranges, i.e. metabolism, muscle mass, fat-free mass, fat mass, intra cellular water and phase angle. Another goal is for you not to obsess about food, body and weight, but to be energized, active and to follow your dreams.
Q9
How long does treatment take?
This is impossible to say. If you follow our plan and your metabolism isn’t too off, it takes 6 – 8 weeks for your metabolism to recover. However, those with more serious problems often take longer to heal. We recommend that you come in once a week, since we need to see you that often to learn how your body is responding to the food plan and suitably adjust course as you are making progress.
Q10
What does a typical eating plan from the Kahm clinic look like?
There is no typical plan, since each one depends on what the machines tell us about your body, and each body is different. And each time you come by we adjust your diet depending on what has happened to your body in the previous week. We don’t recommend particular foods or recipes, we will, however tell you how many calories/day your body needs and we will translate that into food groups so that you can enjoy an endless variety of combinations. We will also guide you how to balance your customized food plan throughout the day.
Q11
Don’t others have these machines?
Yes, some nutritionists have metabolic machines and body-comp analysis. But their metabolic machines are cheaper and give far less information than ours. Our metabolic machine is usually used in large hospitals by cardiologists to see whether patients have cardiac or pulmonary problems. Unlike others, ours show if your body is breaking down muscle and organ tissues (protein substrate utilization), and can see whether you are hypo-metabolic or not. It also sees how you are metabolizing carbohydrates and fat. Other less expensive machines can’t do that, and that is crucial information for diagnosing eating related problems. Beyond it’s incredible usefulness for treating eating disorders and disordered eating, the carbohydrate substrate utilization, for instance, can guide us to screen pre-diabetes at an early stage (one of the risk factors of metabolic syndrome). Using metabolic testing and body composition analysis in tandem and making sense of the data is very difficult and requires long training. As of now, there are only four other places in the country that know how to use these machines as we do. For most other nutritionists, using the metabolic test or the body composition analysis is an optional add-on to their treatment, for us it is utterly central to what we do and we cannot imagine working without them. To read more about the tests, go here.
Q12
Are the numbers triggering for some people, especially for those with eating disorders?
We are very careful not to share exact numbers with our clients. The information provided from our machines are a clinical tool to give the dietitians far better knowledge of the degree of malnutrition and an individualized plan for recovery. Just as eating disorder treatment must often weigh patients and either hide or be very delicate about discussing those numbers, so do we treat the numbers from our machines. We do not share scale weight with our clients, nor do we disclose fat mass. When we discuss the Body Composition Analysis results, we only share trends, for instance, that someone has gained significant muscle mass. We have found that for many clients, talking about the body composition analysis trends is less triggering than just discussing weight alone.
We do, however, share numbers with patients about their metabolic rates, which we check every few months. This information provides us and the patient with a starting point for their meal plans. It helps the patient better understand possible damage that has been caused by the eating disorder or disordered eating patterns.
Q13
I am concerned about fasting prior to my first visit. Is this mandatory for all clients?
Yes, fasting is required for a minimum of 4-5 hours prior to sitting for The Metabolic Test. Our machine is determining an individual's Resting Metabolic Rate (RMR) and fasting is required to get an accurate result. We understand that asking an individual to fast can be challenging, especially for those who have been struggling with restrictive eating. If this is the case, we encourage you to fast for just the minimum amount of time (4 hours) and bring food with you to eat right after we complete the metabolic test. We spend the last portion of our visit discussing results and a meal plan, allowing for plenty of time to eat while we talk. Early appointments are preferable because you wake up fasted, get tested at the appointment, and then have a slightly later breakfast immediately afterwards.
As a reminder, we will only require you to fast for the initial visit. You will NOT have to fast for all follow-up visits.