The importance of a multidisciplinary team
As an outpatient nutrition clinic, our goal is to collaborate closely with outside clinicians to create a successful multidisciplinary team for our patients. As already mentioned, our initial nutritional assessment includes Metabolic Testing and Body Composition Analysis. If and when these test-results indicate that patients are have an eating disorder, which usually means they are hypo-metabolic, malnourished, and catabolic, multidisciplinary integrative care is of utmost importance. The team should include a Physician (for vital signs, blood work, and a bone-density test, etc.), a Psychotherapist (to work on self-esteem, body image acceptance, relationships, etc.), a Psychiatrist if needed (for antidepressants, etc.), and a Nutritionist/Dietitian (for recovery is impossible without food). In severe cases, early treatment and aggressive multidisciplinary interventions are crucial: they drastically increase chances of success and lower the likelihood of relapse and/or chronicity. Eating disorder patients do not need to meet DSM 5’s full criteria for Anorexia or Bulimia to be at serious risk. Because two-thirds of those with eating disorders are not clinically underweight and their blood work is often within normal limits, they need not be underweight to be dangerously ill. Eating disorder patients are often very difficult to diagnose, partly because most of them have a normal or high BMI, and partly because individuals struggling with eating disorders often don’t believe that they have a problem and merit treatment unless they are extremely low weight. Diagnostic criteria routinely overlook some very sick eating disordered patients, and delaying referral frequently leads to much higher levels of care down the road. Compounding this problem is the sad fact that insurance companies are often unwilling to approve higher levels of care until patients are either suicidal or severely physically compromised. One of the great strengths of The Kahm Clinic is that with our tests we can diagnose patients that are often missed by others, and even in relatively obvious cases, we can see the degree to which they are malnourished and sick with far greater accuracy, and with this empirical evidence we can often persuade them to begin the process of recovery much earlier. We can also see more accurately, from a nutritional perspective, when they are fully recovered.
Free Consultations and Presentations
If you are a clinician (MD, therapist, nutritionist, or coach) interested in our practice and want to learn how it can benefit your patients, please come in for a free consultation, so that our nutritionist can show you, first-hand, what we do. With advance notice, we are also happy to come to your office and offer a brief PowerPoint presentation detailing how we can complement your practice and help you serve this patient population better. We are also looking for clinicians, experienced and specialized in treating eating disorders, for our patients. On the other hand, if you refer a patient to us, we will send you a detailed nutritional assessment report with impressions and recommendations.
We encourage our patients to be engaged in therapy and look forward to work closely with their therapist or to refer to a therapist when needed. The Kahm Clinic does not advocate any particular kind of therapy. Different types of therapy will be effective for different persons, and we believe that the trust and bond established by longstanding therapeutic relationships is extremely helpful and necessary in treating eating disorders. Our work compliments and strengthens the crucial therapeutic work, because when patients eat more, they have a greater ability to focus on therapy. While the brain only comprises 3% of the body’s weight, it requires 20% of its energy, which means that it is disproportionally disturbed by caloric restrictions. A starved brain has difficulty focusing, and often manifests obsessive compulsive behaviors, depression, phobias, anxieties, memory retention issues, rumination, etc. All of these symptoms make talk therapy more difficult and less effective. As the brain and body is better nourished, some of these symptoms are significantly weakened, and therapy can more effectively do its work in treating the psychological roots of the eating disorder. Both the physiological and the psychological facets of EDs are utterly crucial to treatment, but in the order of recovery, nutritional healing spurs and aids psychological healing. We work closely with therapists to help each patient as needed.
Eating disorders are notoriously difficult to diagnose. Blood work is often normal and two thirds of those with eating disorders are not underweight – making most patients with eating disorders practically invisible. Also, the symptoms of eating disorders can mask or mimic celiac disease, ulcerative colitis, chronic parasites, and malabsorption, diabetes mellitus, Addison’s disease, hypothyroidism, hypopituitarism and cancers. Patients will often complain about insomnia, gastrointestinal distress, depression, infertility, amenorrhea or oligo-menorrhea, slow-to-heal injuries from exercise, fractures, fatigue, neuropathies, skin conditions, etc. A malnourished body can cause all kinds of symptoms, and treating the various ways that any particular person’s body starts to break down will never get to the physiological cause of the problem, which is malnourishment. And even when an eating disorder is suspected, it is very difficult to prove it and convince them that they need treatment. With our tests, we have empirical data proving their level of malnutrition (and how to correct it), and this data powerfully motivates them to begin recovery. Alternatively, we can also see if they are healthy and rule out a possible eating disorder, helping you to hone in on the real problem.
Because of the complexity of eating disorders, a psychiatrist is often needed as part of the treatment team.
Food is obviously of primary importance for the body and brain. However, for some patients, it can be very difficult to increase intake to an adequate level when the eating disorder voice is strong. Food restriction often causes increased anxiety and/or depression because of altered neurochemistry in the brain. If the patient is not able to increase intake because of obsessive thoughts, psychotropic medication may help to reduce anxiety/depression.
On the other hand, in order for many psychotropic medications to be effective, the body needs to be nourished. We know that medication works poorly in severely underweight malnourished anorexic patients. But since two-thirds of patients diagnosed with an eating disorder are at normal or above normal weight, it is assumed that they are nourished and should thus respond to medication. If and when medication isn’t working as expected in this patient population, Metabolic Testing and Body Composition Analysis will screen those patients (who are “under the radar”) who are malnourished, i.e. hypo-metabolic and catabolic, and who need to be re-fed in order for medication to have desired effect (e.g. higher-weight anorexics, normal weight bulimics, normal weight compulsive exercisers, etc.).