Three Things Nutritionists Need to Know About the Body, Brain, and Eating Disorders

By Carolyn Hodges-Chaffee, MS, RDN, CEDRD-S

The following article was published on Jan. 5, 2020, in Gurze.

The Low Carb Craze

There are countless types of diets that influence people in all walks of life.  But despite their proliferation, popular diets are not based on scientific research, but on individuals who have experienced some degree of “success.”  People would think that following a simple diet for a few months would be harmless, and would hopefully result in some weight change, but the problem is that some diets can be very harmful for certain people.  Diets should not be taken lightly – they should come with warnings just as drugs do.  Just as medications can affect individuals differently, so too can diets.  For example, some individuals can go on a low-carbohydrate diet without experiencing any cognitive changes, but those who are susceptible to lower serotonin levels can quickly become obsessed and develop disordered eating or eating disorders.  The newest low-carbohydrate diet that has gotten America’s attention is the “Keto” diet, which allows for less than 20 grams of “net carbs” daily (calculated by subtracting the grams of fiber from the total number of carbohydrates).

The Carbohydrate-Protein Link to Serotonin Levels

When individuals who are sensitive to lower serotonin levels follow a low-carbohydrate diet, their bodies don’t have enough carbohydrates and protein (building blocks for serotonin) to make the neurotransmitter.  If they continue to limit their carbohydrates, their serotonin levels will decrease and this causes a change in brain chemistry that can increase feelings of guilt, which in turn may lead to eating even less – and the cycle repeats.  For those who have bodies (and brains) that are sensitive to changes in serotonin, this cycle can be the beginning phase of an eating disorder.

If the amino acid tryptophan (found in many protein foods) is the building block for serotonin, why is it so important to have carbohydrates?  When individuals follow a high protein, low carbohydrate diet there are many amino acids that are consumed.  The tryptophan must cross the blood brain barrier (BBB) to increase serotonin levels in the brain.  Protein is made up of several amino acids and these are competing to cross the BBB; tryptophan is not a great competitor so very little is able to cross the BBB unless carbohydrate is present.  This results in a gradual decrease of serotonin.  Carbohydrate causes the body to release more insulin which promotes amino acid absorption and leaves tryptophan in the blood.  If protein is consumed with carbohydrates then the carbohydrate will drive the majority of amino acids into the muscle, thus the tryptophan is able to cross the BBB much easier. (Food & Mood, Somer, 1999)

The Brain-Gut Connection

The brain has about 10-20% of the serotonin in the body, the other 80-90% is found in the gut.  This sets up the perfect storm for the development of an eating disorder.  As serotonin levels decrease in the body, the gut function slows down and individuals feel full much sooner and become very uncomfortable with nausea and/or bloating if they try to eat more.  As the gastrointestinal function decreases, constipation often occurs.  Imagine the individual who was simply trying to diet, as serotonin levels decrease they begin to feel more guilty about eating and at the same time because of the low levels of serotonin in the gut they also feel full sooner, as well as feeling bloated and constipated.  It hurts to eat, so they eat less and this leads to further decrease of serotonin in the body.  Clients often describe a noticeable change in their thought process.  Initially, they could control their eating behaviors and it was a choice about what and when to eat.  After restricting their intake, eventually they become a slave to their thoughts and have to follow the food rules or spend the day obsessing about everything they put in their mouth.

What begins as a well-intentioned attempt to lose weight and follow the new trending low carbohydrate diet is not a harmless endeavor.  Low carbohydrate diets should come with a warning that anyone who has a history or family history of an eating disorder, obsessive compulsive traits, depression, and/or anxiety may be at high risk to develop an eating disorder by limiting their carbohydrate intake.  Researchers are now exploring the differences in brain chemistry that may put some individuals at higher risk to develop an eating disorder.  What we do know is that glucose (a byproduct of carbohydrate metabolism) is the sole fuel for the human brain (except in prolonged starvation). The brain lacks fuel stores and requires a continuous supply of glucose.  (Https://www.ncbi.nlm.nih.gov, “Each Organ Has a Unique Metabolic Profile-Biochemistry-=NCBI bookshelf-NIH).   How can the brain be fed if there isn’t an adequate amount of carbohydrate?

About Carolyn:

Carolyn Hodges Chaffee, MS, RDN, CEDRD-S, is the founder, owner, and director of the Upstate New York Eating Disorder Service -The Nutrition Clinic and Sol Stone Center. Levels of care include outpatient, intensive outpatient (IOP), and partial hospitalization program (PHP) with a supervised overnight residence. Carolyn has more than 30 years of experience in the field of eating disorders.  Since opening, over 8,000 eating disorder patients have been treated. In addition to these services, she helped develop and implement a multidisciplinary campus-wide eating disorder program at Cornell University. She is co-author of “Measuring Health From the Inside,” and co-author of the chapter “What Doctors and Dietitians Need to Know” in Trauma-Informed Approaches to Eating Disorders. She has been a presenter at several regional and national conferences.

Eating disorder seminar set for Dec. 2 in Corning

The importance of communication between the brain and gut and its impact on our health will be explored on Dec. 2 at the 18th Annual Erin Leah Robarge Memorial Eating Disorder Seminar in Corning.

The seminar, “The Brain - Gut Connections: The Revolution in Eating Disorder Treatment,” is from 8 a.m. to 4 p.m. Dec. 2 at Radisson Hotel Corning. The seminar is open to eating disorder professionals, patients, their families and the public.

Dr. Laura Hill

“Research is increasingly focused on the relationship between neurobiology and eating disorders,” said Carolyn Hodges Chaffee, MSRDN, CEDRD, owner and director of Upstate New York Eating Disorder Service and one of the seminar’s co-sponsors. “Neurobiology that can help clinical practice best support people with eating disorders will be explored. Research has shown that changing gut bacteria using diet affects brain function, and can provide information to help develop new strategies to prevent or treat digestive, mental, and neurological disorders.

“The workshop will look at how a better

understanding of this connection will revolutionize the treatment of eating disorders and other mental health disorders.”

There are two keynote speakers:

The morning speaker is clinical psychologist Dr. Laura Hill, Ph.D., FAED, the chief executive and clinical officer with the Center for Balanced Living in Columbus, Ohio. Dr. Hill, a past keynote speaker, returns to talk about the latest research in the brains of patients with bulimia and anorexia. “Dr. Hill has been instrumental in developing the first neurologically based treatment for anorexia nervosa with Dr. Walter Hill,” Chaffee said.

April Winslow

The afternoon keynote speaker is April Winslow, MSRDN, CEDRD, a psychiatric registered dietitian and the founder of Choose To Change Nutritional Services in San Jose, Calif. Winslow will talk about the communication between the brain and gut and how understanding this can help lead to the development of new strategies to treat digestive, mental and neurological disorders. "We know that gut function plays a very important role in revolutionizing the treatment of eating disorders." Carolyn said.

Early registration is $100 by Nov. 25. After Nov. 25, it is $125. There are discounts for businesses, students, and families. Call (607) 732-5646 for more information.

The seminar was established in memory of Erin Leah Robarge, who died in 2000 after a long struggle with an eating disorder. She was 23 years old. The other co-sponsors are ClearPath Healing Arts Center in Corning and Ophelia’s Place in Liverpool, N.Y.

Upstate New York Eating Disorder Service is home to the Nutrition Clinic and Sol Stone Center. The Nutrition Clinic is an outpatient clinic committed to helping eating disorder patients make permanent, healthy lifestyle changes. The Sol Stone Center is a nationally recognized partial hospitalization program that specializes in treating people who have been unresponsive to outpatient care and/or people discharged from inpatient or residential settings.

Body image documentary showing in Big Flats, Ithaca, Vestal and Binghamton

A documentary about body image activist Taryn Brumfitt’s fight to encourage women to be more accepting of their bodies will be shown on different nights in the coming weeks in Big Flats, Vestal, Binghamton, and Ithaca.

Tickets for “Embrace: Your Body, The Movement, Global Change” are $12.70 each except in Ithaca, where tickets are $13.20 each. The 90-minute movie is not rated.

The movie schedule and links for tickets by location:

Ithaca: 7:30 p.m. Oct. 27 at the Regal Cinemas’ Ithaca Mall Stadium 14 theater on Catherwood Road (https://gathr.us/screening/17984).

Big Flats: 7:30 p.m. Nov. 7 at the Regal Cinemas’ Arnot Mall 10 theater on Chambers Road (https://gathr.us/screening/17974).

Vestal: 7:30 p.m. Nov. 15 at the AMC Vestal Towne Square 9 theater on Vestal Parkway (https://gathr.us/screening/18066).

Binghamton: 7:30 p.m. Nov. 23 at the Regal Cinemas’ Binghamton Stadium 12 theater on Front Street  (https://gathr.us/screening/17915).

Upstate New York Eating Disorder Service of Elmira, home of the Nutrition

Taryn Brumfitt

Clinic and Sol Stone Center, is sponsoring the Big Flats and Vestal showings. There are also Nutrition Clinic offices in Vestal and Ithaca.

"It's one of the best films I've seen on body image,” said Carolyn Hodges Chaffee, MS, RDN, CEDRD, the owner and director of Upstate New York Eating Disorder Service. “You leave the movie feeling very positive about all shapes and sizes. There have been several films on body image, but this is one of the first that actually accomplishes a positive feeling toward all."

Brumfitt founded the Body Image Movement after before-and-after photos of her on Facebook sparked controversy. The before photo showed Brumfitt at a bodybuilding competition in 2012, and a second photo showed her sitting naked later that year after she had gained weight.

She told Cosmopolitan magazine: “I loved how I looked in the second shot — I saw a sexy, confident woman. I thought it would be good to share the photos with my friends – to make the point that you can feel good about the ways in which your body changes.”

The photos have had more than 3.6 million views and about 20,000 people shared it, she told Cosmopolitan. Since then, Brumfitt said she has been trying to help redefine and rewrite the ideals of beauty.

“Our job is to harness and facilitate positive body image activism by encouraging women to be more accepting of who they are, to use positive language regarding their bodies and others, and to prioritize health before beauty,” she wrote on her website (bodyimagemovement.com). 

Body image movie coming to Big Flats on Nov. 7

A documentary about body image activist Taryn Brumfitt’s fight to encourage women to be more accepting of their bodies will be shown at 7:30 p.m. Nov. 7 at Regal Cinemas’ Arnot Mall 10 movie theater in Big Flats.

Taryn Brumfitt

Tickets for “Embrace: Your Body, The Movement, Global Change” are $11 and can be purchased online at https://gathr.us/screening/17974. The 90-minute movie is not rated. A minimum of 60 tickets need to be sold for the movie to be shown.

"It's one of the best films I've seen on body image,” said Carolyn Hodges Chaffee, MS, RDN, CEDRD, the owner and director of Upstate New York Eating Disorder Service in Elmira, the sponsor of the Nov. 7 showing of the movie. “You leave the movie feeling very positive about all shapes and sizes. There have been several films on body image, but this is one of the first that actually accomplishes a positive feeling toward all."

Brumfitt founded the Body Image Movement after a before-and-after photo in 2013 on Facebook of Brumfitt sparked controversy. The before photo showed Brumfitt at a bodybuilding competition in 2012, and a second photo showed her sitting naked later that year after she had gained weight.

She told Cosmopolitan magazine: “I loved how I looked in the second shot — I saw a sexy, confident woman. I thought it would be good to share the photos with my friends – to make the point that you can feel good about the ways in which your body changes.” The photo has had more than 3.6 million views and about 20,000 people shared it, she told Cosmopolitan. Since then, Brumfitt has been on a worldwide quest to redefine and rewrite the ideals of beauty, she said.

“Our job is to harness and facilitate positive body image activism by encouraging women to be more accepting of who they are, to use positive language regarding their bodies and others, and to prioritize health before beauty,” she wrote on her website (bodyimagemovement.com). “Our goal is to reach as many women as possible around the world and speak to them about how we can learn to fully embrace and love our bodies.”

Upstate New York Eating Disorder Service is home to the Nutrition Clinic and Sol Stone Center. 

The Nutrition Clinic is an outpatient clinic committed to helping eating disorder patients make permanent, healthy lifestyle changes.

The Sol Stone Center is a nationally recognized partial hospitalization program that specializes in treating people who have been unresponsive to outpatient care and/or people discharged from inpatient or residential settings.

Carolyn Hodges Chaffee to discuss new book at Ophelia's Place on Nov. 27

Carolyn Hodges Chaffee, the owner and director of Upstate New York Eating Disorder Service, will discuss her innovative new book

on treating eating disorders, “Measuring Health From The Inside: Nutrition, Metabolism and Body Composition,” during a talk and book signing from 5 to 7 p.m. on Friday, Nov. 27, at Ophelia’s Place and Café 407 at 407 Tulip St. in Liverpool, N.Y.

Carolyn, a certified eating disorder specialist, and Annika Kahm, an eating disorder therapist and nutritionist in private practice in

Carolyn Hodges Chaffee

Stamford, Conn., wrote the book for clinicians, patients and their families. It explains why two simple measurement techniques are invaluable tools in helping to assess and treat eating disorder patients, Carolyn said.

“Body Composition Analysis and Metabolic Testing are being used in research, but very few clinicians are using them to help treat those struggling with an eating disorder,” she said. “It is our hope that by writing this book, clinicians will become more familiar with the testing and incorporate it as part of their standard of care.”  

Body Composition Analysis is a measurement of the body’s lean mass, fat mass, hydration status, and phase angle (which helps assess how healthy a person is at the cellular level). The results also help determine the long-term impact malnutrition has had on a body.

Metabolic Testing is an actual measurement of the body’s

resting energy expenditure. The results are used to accurately assess the current nutritional status of the patient. The test results show how the body adapts to being underfed. Metabolic Testing determines how many calories a body is burning at rest with no activity. It also shows if the body is breaking down its own protein stores.

“Measuring Health From The Inside: Nutrition, Metabolism and Body Composition” is $13.99 for the paperback book and $9.99 for the e-book at friesenpress.com, and is available from other online retailers.

To read excerpts and learn more about the book, go to measuringhealthfromtheinside.com.

Upstate New York Eating Disorder Service is home to the Nutrition Clinic and Sol Stone Center. The Nutrition Clinic is an outpatient clinic committed to helping eating disorder patients make permanent, healthy lifestyle changes. The Sol Stone Center is a nationally recognized partial hospitalization program that specializes in treating people who have been unresponsive to outpatient care and/or people discharged from inpatient or residential settings.

Ophelia’s Place provides support, education and treatment for people with eating disorders and includes a Nutrition Clinic office that provides medical and outpatient treatment services. Learn more at opheliasplace.org.

BOOK URGES NEW TOOLS FOR TREATING EATING DISORDERS

Carolyn Hodges Chaffee, Annika Kahm say testing
is simple and invaluable way to improve patient care.

Carolyn Hodges Chaffee and Annika Kahm are co-authors of a new book that explains the importance of using two simple measurement techniques that are invaluable tools in helping to assess and treat eating disorder patients.

Carolyn, MS, RDN, CEDRD, the owner and director of Upstate

Carolyn Hodges Chaffee

New York Eating Disorder Service in Elmira, and Annika, MS, an eating disorder therapist and nutritionist in private practice in Stamford, Conn., wrote “Measuring Health From The Inside: Nutrition, Metabolism and Body Composition” to help clinicians, patients and their families.

“Both Metabolic Testing and Body Composition Analysis are being used in research, but very few clinicians are using them to help treat those struggling with an eating disorder,” said Carolyn, a certified eating disorder specialist. “It is

our hope that by writing this book, clinicians will become more familiar with the testing and incorporate it as part of their standard of care.”  

Body Composition Analysis, done by electrical impedance, is a measurement of the body’s lean mass, fat mass, hydration status, and phase angle (which helps assess how healthy an individual is at the cellular level). The results also help determine the long-term impact malnutrition has had on the body.

Metabolic Testing, or indirect calorimetry, is an actual

Annika Kahm

measurement of the body’s resting energy expenditure. The results are used to accurately assess the current nutritional status of the patient. The test results show how the body adapts to being underfed. Metabolic Testing determines how many calories a body is burning at rest with no activity. It also shows if the body is breaking down excessive protein stores.

The book is receiving national attention.

“Carolyn and Annika bring decades

of expertise in the care of patients with anorexia, bulimia, binge eating disorder, and the many related atypical and subsyndromal variants,” said Dr. Diane Mickley, director of the Wilkins Center for Eating Disorders in Greenwich, Conn. “Their clinical wisdom, understanding of the experience of sufferers and those who love them, and understanding of these illnesses and the recovery process infuse these pages.”

Mary Ellen Clausen, the founder of Ophelia’s Place, an eating disorder prevention and advocacy center in Liverpool, N.Y., said “Measuring Health From The Inside” reveals the truth about our bodies’ needs and invites us to be part of the healing and recovery process.

“It is a profound book that will forever change how we see and treat this devastating disease,” Clausen said.

Dr. Mickley, writing in the Foreword, said “Measuring Health From The Inside” shines a light on a valuable addition to the treatment of eating disorders: Metabolic Testing and Body Composition Analysis.

“These are noninvasive assessments with immediate results. The results show patients numerically and graphically if they have slowed their metabolism and if they are burning off muscle for lack of fuel. The testing provides objective data on how many calories the patient needs, as well as what is an accurate ideal weight.”

Question: Are you and Annika writing the book for treatment professionals?

Carolyn: Yes, but it is also for patients and their family members. The use of these two tests encourages patients to become a partner in their recovery process. The more knowledge patients have about why their body responds the way it does, or why they physically feel the way they do, the easier it is to make changes in their intake or behaviors. There are educational sections about the different disorders and behaviors and how to effectively use and apply the testing in the treatment process. The book opens with chapters on malnutrition and the eating disorder “voice,” followed by an explanation of the Metabolic Testing and Body Composition Analysis.

We dedicated chapters to Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Compulsive Exercise, and Other Specified Feeding and Eating Disorders.

We also have chapters explaining healthy eating, treatment protocols, and how and when to access higher levels of care. We conclude with a look at why recovery is not a linear process and how patients can sustain long-term recovery.

Annika: It’s important to have other clinicians on a patient’s treatment team who are not familiar with Body Composition Analysis and Metabolic Testing understand why I push for higher weight based on the numbers. So frequently when I work with other clinicians, they settle for too low discharge weight and let the patient think that that is their goal weight. This becomes hard for the patient, so the book is needed for other clinicians on the team to respect, accept and support the patient to reach a healthy weight goal range.

Question:  Why is this book important in your practice?

Annika:  When I see a patient for the first time, I go over and explain all the numbers from the tests, and make sure they understand the concept. What frequently happens is that a couple of days later, they are back to their own (eating disorder) thinking and don’t trust the concept. With the book, they and their support team can be reassured that what we initially planned is the right treatment. In other words, with the book, they can trust the treatment sooner and it becomes a time-saver for the patient and me as well.

Question: Will patients and their families understand?

Carolyn: We wrote this for everyone affected by eating disorders. It is written in a way to make it accessible for all readers. We had many editors and readers help us find the right balance for professionals and non-professionals.

It is our hope that clinicians incorporate the testing as part of their practice, and patients seek clinicians who use these treatment methods. Patients and their families need to know there are resources available they may not be aware of. 

Question: Have your patients requested more information about testing?

Annika: Patients frequently struggle with the treatment based on the test results, especially when they need to eat more in order to, for example, lose weight.

The message may seem counterintuitive and not only they but their loved ones may question it as well. As an example: “You went to the nutritionist in order to lose 30 pounds, and she wants you to eat more?” With the book, they and their loved ones can read why they need to eat more initially in order to lose weight.

Question: Why did you write this book?

Carolyn:  Colleagues, patients, and family members are always saying:  Why don’t you write a book? Or they would ask me to suggest a book they can read that will provide more information about metabolism, malnutrition, and the testing. This book fills that gap. It helps everyone better understand the how and why the body works the way it does.

> Go to measuringhealthfromtheinside.com to learn more about the book and read excerpts.

Excerpts from 'Measuring Health From The Inside'

■ Both the Metabolic Testing and Body Composition Analysis are extremely helpful in convincing the individual and their family that starvation is affecting the body. Too often, if they do not “look sick” (e.g., have a low body weight), there is much denial from both the patient and/or the family. When faced with concrete data that shows the body is malnourished based on the test results, the patient and family are much more able to understand the severity of the illness. These two tests help convince even the most difficult patient that he or she is doing damage to the body and that they need to follow the recommendations to correct it. A typical reaction from a patient is, “I didn’t realize I was doing any damage to my body; I thought I was just being healthy.”

■ From a patient: “The initial evaluation was a wake-up call. My bloodwork was always normal despite the fact I might purge as many as six to ten times a day. The Metabolic Test showed how few calories I was burning and that I was using my own lean tissue, not fat, to exist. This was the first test that ever indicated that there was something wrong.”

■ Our overall philosophy in working with eating disorders is: “You can’t do anything different until you see it differently.” As clinicians, this philosophy is infused into our practices and influences us to incorporate Metabolic Testing and Body Composition Analysis into our treatment protocol. It drives us to break away from numbers on a scale and instead to measure health from the inside. We also try to impart this way of thinking to our patients so they’re not relying on numbers on a scale when gauging their recovery. Instead, they’re tuned in to changes in their bodies, as well as the way they think about themselves.

> Go to www.measuringhealthfromtheinside.com for more book excerpts.