Healthy Eating & Eating Disorders - Anorexia, Bulimia, Binging

Name: Healthy Eating & Eating Disorders - Anorexia, Bulimia, Binging
Uploaded: 2021-09-06T12:00:02.000Z
Duration: 4 h 32 min 19 s

Introduction

In this section, Andrew Huberman introduces himself and the topic of healthy and disordered eating. He emphasizes that the discussion will include what it is to have a healthy relationship with food.

Introduction to Healthy and Disordered Eating

Andrew Huberman introduces himself as a Professor of Neurobiology and Ophthalmology at Stanford School of Medicine.

The topic of discussion is healthy and disordered eating, including clinical eating disorders such as anorexia, bulimia, and binge eating disorder.

The discussion will also cover metabolism, how eating frequency influences appetite and satiety, psychological relationship to food, body weight, and body composition.

Intermittent Fasting

In this section, Andrew Huberman discusses intermittent fasting. He explains what it is and why people are excited about it.

What is Intermittent Fasting?

Intermittent fasting involves restricting one's feeding behavior to a particular phase of the 24-hour or circadian cycle.

Other forms involve not eating for extended periods of time for an entire day or more.

During these times, it's important to drink water and ingest electrolytes such as salt, potassium, and magnesium.

Benefits of Intermittent Fasting

Satchin Panda's lab identified health benefits in mice from restricting one's feeding window during each 24-hour cycle.

Some studies in humans have also shown that intermittent fasting can be beneficial for various health parameters.

It can improve liver enzymes and insulin sensitivity.

Metabolism & Weight Loss

Regardless of whether or not you intermittent fast or eat small meals all day long, the calories that you ingest from whatever source are going to be filtered through the calories that you burn.

This includes exercise and basal metabolic rate.

Why People Prefer Intermittent Fasting

Many people prefer intermittent fasting because they find it easier than other forms of diet or nutritional frameworks.

Different Approaches to Eating

This section discusses the two categories of people when it comes to eating habits.

Two Categories of People

There are two categories of people: those who prefer not to eat in the morning and push their feeding window out to noon or 2:00 P.M., and those who prefer to eat early in the day but limit their feeding window such that they cut off their food intake somewhere around 5:00 P.M.

The duration of the feeding window varies based on lifestyle and circumstances, so there is no ideal length for everyone.

People tend to fall into one category or the other, but there is no evidence that one approach is better than the other in terms of weight loss or overall health parameters.

Some people choose to skip lunch because they're busy during the day, which doesn't afford them a long fast associated with sleep.

Eating Disorders and Sleep Eating

This section talks about eating disorders and sleep eating.

Sleep Eating Disorder

Most people do not eat while they are asleep, but there is a disorder where people actually eat in their sleep called sleep eating disorder.

Sleep eating disorder has a very interesting underlying mechanism.

Defining Healthy Eating

This section emphasizes that nobody knows what truly healthy eating is.

Nobody Knows What Truly Healthy Eating Is

Nobody knows what truly healthy eating is. We only know measurements like liver enzymes, blood lipid profiles, body weight, athletic performance, mental performance, etc.

These measurements have strong cultural, familial, and socio-societal influence.

Clinically diagnosable eating disorders have serious health hazards and even the risk of death.

Thinking, Decision-Making, and Homeostatic Processes

This section introduces a framework for understanding healthy and disordered eating.

Framework for Understanding Healthy and Disordered Eating

The framework includes an understanding of thinking, decision-making, and homeostatic processes that regulate things going on in our brain.

Study on Muscle Hypertrophy and Protein Intake

This section discusses a study that explored the impact of protein intake timing on muscle hypertrophy, growth, and overall protein synthesis in mice and humans.

Study Overview

The study looked at giving mice or humans two meals.

Explored whether putting those meals early in the day or late in the day had an impact on muscle hypertrophy, muscle growth, and overall protein synthesis of muscle.

Explored how protein intake, which included branch chain amino acids and amino acids like leucine important for muscle protein synthesis, affected muscle hypertrophy.

Mice were used during their active phase of their circadian cycle which corresponds to our day. In humans, they looked at whether eating most of one's protein early in the day was better than if the protein intake was placed later in the day.

Resistance Training

Mice did resistance training by emphasizing overload to one limb of the mouse generating hypertrophy.

Humans underwent resistance training with an exploration of grip strength.

Key Takeaways

Mice and humans can utilize amino acids ingested early in the day better than they can utilize amino acids ingested later in the day towards muscle hypertrophy and growth or maintenance of muscle.

Ingesting a high-protein meal early in the day ought to be beneficial for maintaining or increasing muscle mass.

Loss of skeletal muscle is one of the major causes of injury as we age.

Eating Protein Early in the Day

In this section, the speaker discusses how eating protein early in the day can lead to increased muscle synthesis. The circadian clock mechanism present in all cells, including muscle cells, plays a vital role in this process.

Importance of Eating Protein Early

Ingesting protein early in the day leads to more synthesis of muscle than ingesting protein later in the day.

Proteins that are ingested later in the day are not utilized as well as those ingested earlier.

Between 5:00 A.M. and 10:00 A.M. is the critical window for increased protein synthesis.

Mechanism Behind Increased Muscle Synthesis

Muscles have fibers with cells containing nuclei that contain DNA.

DNA is transcribed into RNA which is translated into proteins.

Each cell has a pattern of gene expression that varies across the 24-hour cycle due to circadian regulation.

BMAL gene downstream of circadian regulation influences protein synthesis.

Absence of BMAL gene eliminates effect of increased protein synthesis early in the day.

Recommendations for Maintaining or Enhancing Muscle Tissue Volume

Consider eating quality protein and amino acids early in the day if interested in maintaining or enhancing muscle tissue volume.

Quality protein includes most essential amino acids, particularly leucine.

Importance of Quality Proteins Early in the Day

This section discusses how every cell in our muscles has a clock gene, and protein synthesis is greater early in the day than later. It also emphasizes that getting quality amino acids early in the day from whatever foods are in alignment with your particular values and eating plan is important.

Key Takeaways

A small piece of chicken or steak or eggs for instance, will have many essential amino acids with a low caloric content relative to say beans or plant-based food that can also get you essential amino acids.

Ingestion of quality proteins early in the day will be more incorporated into muscle than the proteins ingested late in the day due to circadian BMAL gene related mechanism.

Nobody knows what healthy feeding windows are, what the best feeding windows are. There's absolutely no information on that context.

For the treatment of eating disorders, it doesn't matter what psychological or early trauma based effects led to the eating disorder. If the person isn't adjusting their feeding behavior in a way that is going to ameliorate the symptoms of that disorder, which is ultimately the goal.

Belcampo: Regenerative Farming

This section talks about Belcampo, a regenerative farm in Northern California that raises organic grass-fed and finished certified humane meats.

Key Takeaways

Belcampo's animals graze on open pastures and seasonal grasses their entire lives resulting in meat that's higher in nutrients and healthy fats.

Belcampo's meats are known to be high in omega threes because they're grass-fed and grass-finished.

First-time customers can get 20% off by going to belcampo.com/huberman and using the code huberman@checkout.

Headspace: Meditation App

This section talks about Headspace, a meditation app that's backed by 25 published studies and has over 600,000 five-star reviews.

Key Takeaways

Headspace is a meditation app that's backed by 25 published studies and has over 600,000 five-star reviews.

The podcast is brought to us by Headspace.

Meditation and Athletic Greens

In this section, the speaker talks about meditation and Athletic Greens.

Meditation

The speaker meditates for 3-5 minutes or ideally two 20-minute sessions per day.

Headspace app has different meditations that allow you to tailor your meditation practice to your particular schedule.

There are studies showing the benefits of a regular meditation practice.

Athletic Greens

Athletic Greens is a vitamin mineral probiotic drink that helps cover all nutritional bases with respect to vitamins, minerals, and probiotics.

A healthy gut microbiome is supported by probiotics, which can be obtained through Athletic Greens.

Drinking Athletic Greens gives more energy and makes one feel better. It tastes good when mixed with water and lemon juice.

If you want to try Athletic Greens, go to athleticgreens.com/huberman for a special offer of five free travel packs and a year supply of vitamin D3 and K2.

Eating Disorders

In this section, the speaker talks about eating disorders.

Self-Diagnosis

Nobody can define what healthy eating is with a single protocol but there is general agreement on what unhealthy and disordered eating is.

Clear criteria exist in psychiatric and psychological communities to define things like anorexia bulimia, binge eating disorder, etc., but diagnoses need to be carried out by people who are trained in that particular field with deep expertise in recognizing symptomology including some of the more subtle symptomology of eating disorders.

Self-diagnosis can be both a terrific and precarious thing.

Seeking Professional Help

If any of the symptoms resonate with you, take that information to a qualified healthcare professional that could diagnose or rule out any of these possible disorders.

Information is valuable, but one shouldn't start to self-diagnose simply on the basis of symptomology.

Introduction to Eating Disorders

This section introduces the topic of eating disorders and focuses on anorexia nervosa, which is the most prevalent and dangerous of all eating disorders.

Anorexia Nervosa

Anorexia nervosa is a failure to eat enough to maintain a healthy weight.

Symptoms include loss of muscle mass, low heart rate, low blood pressure, fainting, hair growth on the face, loss of bone density, osteoporosis, loss of periods in girls and women, and disrupted gut and immune functions.

Anorexia nervosa has existed at essentially the same prevalence for the last 100-400 years. It occurs at 10 times the rate in women than it does in men.

There seems to be a strong biological contribution to anorexia nervosa. However, it can be treated or cured.

Bulimia

Bulimia is defined as binge eating or overeating. Binge eating is consuming vast amounts of calories in a short period of time while overeating can be ingesting more calories than one needs but over an extended period of time.

Introduction to Bulimia

This section introduces bulimia and discusses the increase in its rates. It also debunks some common misconceptions about the disorder.

What is Bulimia?

Bulimia is a disorder characterized by binge eating followed by purging.

There is no direct correlation between bulimia and early childhood trauma or sexual abuse.

Both anorexia and bulimia have clear biological underpinnings that drive under-eating or overeating.

Comorbidity and Categorization of Eating Disorders

Anorexia and bulimia can coexist with one another, leading to overlap between the two categories.

Loss of menstrual cycles is a classic symptom of anorexia, which has led to categorizations of other eating disorders like binge eating disorder and OSFEDs (specified feeding or eating disorder).

Today, there are many different types of eating disorders, but this section will mainly focus on anorexia, bulimia, binge eating disorder, and body dysmorphia.

Understanding Hunger and Satiety

In this section, the speaker discusses hunger and satiety, how they are regulated by the brain and body, and the different types of information that are communicated to the brain.

Hunger and Satiety Mechanisms

Hunger is triggered by neurons in our hypothalamus that stimulate feeding while satiety is triggered by neurons that stop eating.

Mechanical information such as stomach fullness sends signals to the brain to stop eating while chemical information such as blood glucose levels also signal to areas of our brain stem involved in satiety.

Volume and mechanical influences have a profound effect on how we think about food while chemical effects like blood glucose levels regulate hunger and satiety.

Brain Signaling for Eating

The hypothalamus contains neurons that control appetite, sexual activity, body temperature regulation, etc.

POMC neurons act as a brake on appetite while AgRP neurons stimulate feeding.

Sunlight exposure can ramp up POMC neuron activity leading to lower appetite in summer months.

Conclusion

Understanding how hunger and satiety are regulated can lead us to better understand healthy eating habits for most people.

AgRP Neurons and Appetite

This section discusses the role of AgRP neurons in appetite regulation.

AgRP Neurons and Eating Behavior

In mice and humans, lesions or neurotoxic effects on AgRP neurons lead to anorexia, while stimulation of these neurons leads to hyperphagia.

Elevated levels of AgRP neurons cause anxiety and overeating until the point of bursting.

Leptin is a hormone secreted by body fat that suppresses appetite when there is sufficient body fat. Disrupted leptin signaling is associated with bulimia, obesity, and binge eating disorder.

Anorexics stop having periods due to insufficient leptin in the bloodstream. Attempts to give leptin injections have not been successful in alleviating anorexia.

Signaling Mechanisms for Appetite Regulation

Body fat signals to the brain about how much reserve energy is available through leptin secretion.

The gut sends signals to the brain about sufficient fatty acids, amino acids, and sugars from ingested food.

Two categories of neurons regulate appetite: one acts as an accelerator (AgRP neuron), while the other acts as a brake (leptin).

Hunger and Satiety Mechanisms

This section discusses the biological mechanisms behind hunger and satiety. The speaker explains how mechanical and chemical signals from fullness or absence of fullness, glucose levels in the blood, body fat, and neurons in the gut all converge to regulate hunger.

Biological Mechanisms of Hunger and Satiety

When blood glucose metabolism is disrupted or leptin signaling is disrupted, metabolic disorders can occur.

Mechanical and chemical signals come from fullness or absence of fullness, glucose levels in the blood, body fat, and neurons in the gut to regulate hunger.

Dr. Casey Halpern explains that it makes sense from an evolutionary standpoint for humans to eat as often as they can, as much as they can, and as fast as they can because food was scarce and seeking food was dangerous.

Humans have a hardwired circuit that pays attention to how much food is available now and how much we are likely to get in the future.

Why Do We Eat Despite Having Enough Energy?

This section explores why humans would desire to eat more despite having sufficient energy levels. The speaker explains that this primitive biology evolved over many years where food was scarce.

Evolutionary Biology of Eating

Dr. Casey Halpern explains that it makes sense from an evolutionary standpoint for humans to eat as often as they can, as much as they can, and as fast as they can because food was scarce.

Seeking food was dangerous whether it was from animal sources or not.

Every animal including humans has a hardwired circuit that pays attention to how much food is available, how much we are getting now and how much we are likely to get in the future.

The Arcuate Nucleus and Hunger Regulation

This section discusses the arcuate nucleus in the hypothalamic area of the brain, which houses neurons that regulate hunger and satiety. These neurons become active when we see or think about food, driving hunger in response to various signals.

Neurons in the Arcuate Nucleus

The arcuate nucleus contains PMOC neurons and other types of neurons that regulate hunger and satiety.

These neurons become active when we see or think about food, driving hunger in response to various signals such as what the food looks like, smells like, our prior history with it, social context, etc.

Implications for Eating Disorders

Primitive reflexes drive us to ingest as much food as possible quickly whenever we interact with it.

Eating disorders like bulimia can be thought of as an unmasking of this mechanism without top-down control mechanisms used to regulate behavior.

Bulimia and binge-eating disorder are closely associated with impulsivity and impulsive behaviors.

Decision Making: Should vs. Actually Do

This section introduces a simple box diagram model for decision making that applies to all behaviors. It explains how homeostatic processes (regulating balance between different systems in your body) and reward systems intervene between knowledge of what one should do versus what one actually does.

Box Diagram Model for Decision Making

Two boxes represent knowledge of what one should do versus what one actually does.

Intervening forces between these two boxes are homeostatic processes (regulating balance between different systems in your body) and reward systems.

Anorexia and bulimia are disruptions of these homeostatic and reward processes, leading to completely disrupted decision-making.

For anorexics or bulimics, the signals from the body and brain that say "you need food" aren't registering in the same way as for other individuals.

Understanding Anorexia

In this section, the speaker discusses anorexia and its underlying mechanisms. They also dispel common myths about anorexia.

Anorexia Mechanisms

Interventions for anorexia should tap into the thinking patterns around food, behavior, ingestion or restriction of food, homeostatic processes, and reward systems.

Anorexics have good decision-making skills but disrupted habits. Building and breaking new habits is one of the most effective treatments for anorexia.

Anorexia is a failure to consume enough energy that can lead to severe metabolic disorders and lack of bone density.

Myths About Anorexia

Anorexia has been described since the 1600s and occurs in cultures where food is scarce.

The idea that unrealistic imagery about bodies causes or amplifies anorexia is not supported by data.

To meet the classification for anorexia, there must be a hormonal disruption such as menstrual abnormalities or low testosterone in males.

Puberty and Anorexia

In this section, the speaker discusses how puberty affects brain circuitry and how it relates to anorexia.

Puberty Changes

Puberty is a significant developmental step that changes the body, brain, perceptions, self-perception driven by changes in circuitry within the hypothalamus.

Anorexia tends to show up around puberty in individuals who find food aversive due to psychological reasons such as fighting for autonomy or control over their lives.

Adolescence and puberty is also when girls start menstruating typically.

Negative Effects of Anorexia

This section discusses the negative effects of anorexia on the body.

Downstream Negative Effects

Hypogonadism: lack of sperm production or healthy egg production.

Reduced insulin secretion: insulin is released to help shuttle glucose into various tissues for energy utilization.

High levels of cholesterol: Cholesterol is manufactured by the liver and in anorexics who consume very little food, they often have high levels of cholesterol.

Elevated levels of things like vasopressin: hormones that regulate body temperature and salt and blood volume.

Low blood pressure, passing out, low thyroid levels, and heart rates are also common symptoms.

Causes of Anorexia

This section discusses possible causes of anorexia.

Possible Causes

Failure of AgRP neurons to stimulate appetite and feeding

Too much anxiety around food

Food restriction used for reward in the household

Genetic predisposition towards anorexia exacerbated by praise or desire to be a low body weight for aesthetic reasons.

Genetics and Behavior

This section discusses how genes can influence behavior.

Genetics and Behavior

Genes bias probabilities for behavior.

Behavioral changes can ratchet into neural circuitry if rewarded enough times.

Understanding Anorexia

In this section, the speaker discusses the neural circuitry and behaviors of anorexics to understand what they are truly suffering from at the level of cause.

Chemical Defects

The speaker explores whether there is a chemical defect that makes anorexics anorexic.

There are many chemicals in the brain and body, but neuromodulators like dopamine, acetylcholine, norepinephrine, and serotonin are particularly important.

Serotonin tends to increase the activity of certain neural circuits that trigger a sense of satiety or having enough food. Drugs that increase serotonin levels tend to make one less hungry.

Habits and Behaviors

Dr. Joanna Steinglass and colleagues at Columbia University did work on habits and behaviors of anorexics as ideal places for intervention.

The speaker describes their work as beautiful.

Cognitive Behavioral Therapy for Anorexia

In this section, the speaker discusses cognitive behavioral therapy (CBT), which is a type of talk therapy used to treat eating disorders like anorexia.

What is CBT?

CBT is a type of talk therapy that helps people identify negative thoughts and feelings about themselves and replace them with positive ones.

It involves identifying triggers that lead to disordered eating behaviors and developing coping strategies to deal with those triggers.

How Does CBT Help Treat Anorexia?

CBT can help change distorted thinking patterns related to food, weight, and body image.

It can also help people develop healthy eating habits and improve their self-esteem.

CBT is often used in combination with other treatments, such as medication and nutritional counseling.

Family-Based Therapy for Anorexia

In this section, the speaker discusses family-based therapy (FBT), which is a type of therapy used to treat anorexia in adolescents.

What is FBT?

FBT involves the entire family in the treatment process.

The therapist works with the family to help them understand anorexia and its effects on their loved one.

The goal of FBT is to empower parents to take charge of their child's recovery.

How Does FBT Help Treat Anorexia?

FBT helps parents learn how to support their child's recovery by monitoring meals, setting limits, and providing emotional support.

It can also help improve communication within the family and reduce conflict around food and eating.

Anorexia and Perception of Food

This section discusses the unique perception of food in anorexics.

Anorexic Perception of Food

Anorexics have a hyper awareness of the fat content of foods, almost to the point of being sort of fat content savant.

They actively avoid high-fat content, calorie-rich foods, and default towards very low-calorie foods.

Anorexics learn this information subconsciously and pass it off to a reflexive habit.

The hallmark feature of a habit is that it's reflexive.

Habits

This section discusses habits and how they are formed.

Stereotyped Behaviors

People follow trajectories from their car that are remarkably stereotype.

Their behaviors are so stereotyped to the point where if you were to see them laid out in front of you, you would be amazed by how much like robots we all are.

That robotic aspect of our neurocircuitry is vital.

Anorexia and the Brain

In this section, Dr. Huberman discusses a study on anorexics and how their brain areas associated with habit formation and execution are the best point of intervention.

Brain Areas Associated with Habit Formation

The brain areas associated with habit formation and execution are the best point of intervention for anorexics.

An FMRI scanner was used to evaluate which brain areas are active during particular tasks.

Reward-based decision-making is controlled by a brain area called the ventromedial prefrontal cortex.

DPO (duration path outcome) processes are used in goal-related behaviors such as completing a workout or going to the grocery store.

Prefrontal Cortex and Decision-Making

Duration path outcome (DPO) processes rely on the prefrontal cortex, which allows you to take information from memory, combine it with information about what's happening in the present context, and then direct your behavior toward particular outcomes.

Reflexes don't involve the prefrontal cortex in the same way as habits do.

Decision-making is metabolically demanding because it takes effort.

Study on Anorexics

An FMRI scanner was used to examine brain activity in anorexics who were selecting different foods.

The dorsal lateral prefrontal cortex is involved in decision-making.

Understanding the Anorexic Brain

In this section, we learn about the brain areas that drive the habit of avoiding particular foods and approaching other foods in anorexics. We also learn about the reward systems that have been attached to the execution of habits in a way that is unhealthy for body weight.

The Dorsolateral Striatum

The dorsolateral striatum is a big area in the brain involved in evaluating and decision-making around food.

Anorexics have a brain area that's involved in evaluating and decision-making around food, called dorsal lateral striatum.

The dorsolateral striatum is part of a set of circuits involved in go no-go tasks where behaviors are selected to perform or suppress.

Reward Systems

The anorexic brain rewards suppression of one set of behaviors (ingestion of high calorie foods) and hyper-focus on consumption of low fat, low calorie foods.

Anorexics feel good when they avoid certain foods and approach others due to dopamine release from approaching low fat, low calorie content foods.

Homeostatic processes are disrupted as there's very little body fat, no leptin, shutdown periods for sperm production, and lowered testosterone.

Intervention

To intervene with anorexia nervosa, we need to target habits since it has already passed through all learning and reward systems.

Understanding and Breaking Habits in Anorexia

In this section, the speaker discusses how to break a habit related to anorexia by intervening in the neural circuitry. The focus is on teaching individuals about their internal state and how to register it, so they can start to learn how to associate interactions with different types of food with the sorts of cues that are occurring within their body.

Breaking a Habit

To break a habit, you need to intervene in the neural circuitry related to the habit itself.

Teaching individuals about their internal state and how to register it is key.

Constraint type behaviors are ways of keeping oneself from temptation.

A combination of teaching the individual about their internal state and noticing cues within their body can help them start to intervene.

Weak Central Coherence

Weak central coherence is an inability to see the forest through the trees.

Anorexics have hyper acuity and focus on details within a given environment.

This has elements of obsessive-compulsive disorder but isn't really OCD per se.

Challenge in Set Shifting

Once you identify something that's driving some sort of reward, for an anorexic that would be identifying high-fat foods or identifying one food on the table that one could eat without anyone hopefully noticing, set shifting becomes challenging.

Anorexia and Cognitive Behavioral Therapy

This section discusses how anorexics navigate meals, the importance of habit reformulation, and the effectiveness of cognitive behavioral therapy in treating anorexia.

Anorexics' Meal Navigation

Anorexics push food around their plate to keep people's awareness away from what they're doing.

They constantly monitor how much people are observing them and try to navigate through meals like a "Where's Waldo" game.

The reward for anorexics is in the avoidance of certain foods and acquiring only low-fat, low-calorie foods that their brain rewards them for.

Habit Reformulation

Once anorexics learn about their behavior, they can intervene with support from family-based models.

Family-based models involve making the entire family aware of the individual's challenges with eating disorders or other disorders.

Individuals are taught about neuroplasticity and given autonomy to observe their own habits.

Cognitive Behavioral Therapy

Cognitive behavioral therapy is often done in conjunction with pharmacologic therapies.

The combination of cognitive behavioral therapy that includes habit reformulation seems to be fairly effective in treating anorexia.

Relapse rates for anorexia are high but teaching individuals early on has positive outcomes over time.

Chemical Treatments for Anorexia

This section discusses clinical trials exploring chemical treatments such as MDMA and siliciden for treating eating disorders.

Clinical Trials

Clinical trials at Johns Hopkins School of Medicine explore how drugs like MDMA and siliciden can help people rewire their brain in a professionally supported therapeutic environment.

Eating disorders are also being explored in the context of MDMA and siliciden clinical trials.

These compounds are not yet legal, and clinical trials are essential before exploring them.

Clinical Trials and Safety

This section discusses the importance of waiting for clinical trials to be completed before using serious compounds to treat eating disorders. The speaker emphasizes the need for safety measures and more data.

Waiting for Clinical Trials

The speaker believes that people should wait until clinical trials are done before approaching serious compounds.

Although the data looks promising, clinical trials are still ongoing, and it is important to have safety measures in place.

People are going out of the U.S. to countries where these treatments are being done more regularly, but the clinical trials in this country are not complete.

Importance of Safety Measures

More data is needed on the effectiveness of these treatments.

Safety aspects must be in place before pursuing these treatments.

The speaker has heard evidence both for and against using ibogaine treatments for eating disorders.

Breaking Habits through Self-Awareness

This section discusses how breaking habits related to anorexia requires self-awareness and understanding where those habits come from. It also emphasizes how knowledge can help individuals make better decisions.

Understanding Habits

Breaking habits related to anorexia requires self-awareness of where those habits come from.

Knowledge can allow individuals to make better decisions.

Anorexics often overexercise as part of their habit, but shifting towards resistance training can be beneficial.

Rewarding Healthy Habits

Shifting towards activities like resistance training can help build muscle and put on weight in a healthy way.

Certain forms of exercise are catabolic and break down muscle, while others are anabolic and allow muscle to be put on.

Encouraging anorexics to see food as a way to nourish their body can help them maintain a stable weight.

Conclusion

This section emphasizes the importance of maintaining a healthy weight and body through resistance training and proper nutrition.

Maintaining a Healthy Weight

Once anorexia is under control, it is important to maintain a healthy weight through resistance training and proper nutrition.

Anorexia and Distorted Self-Image

This section discusses anorexia, the benefits of fidgeting for weight loss, and the distorted self-image that anorexics have.

Fidgeting for Weight Loss

Fidgeting can burn anywhere from 800 to 2000 calories a day.

By fidgeting and bouncing around, you can burn body fat if you're in a caloric deficit.

Fidgeting is a pretty terrific way to burn off more calories.

Encouraging Healthy Activity for Anorexics

Encourage anorexics to shift towards activities like weight-bearing or resistance training that promote anabolic activity instead of constantly trying to burn off calories.

Shifting towards these activities can be beneficial since it's challenging to encourage them not to constantly try to burn off calories.

Distorted Self Image in Anorexia

An aspect of anorexia that has received a lot of attention is the distorted self-image.

Anorexics often see themselves as overweight or imperfect in ways that are obsessive for them.

They have a genuine distortion of their self-image so much so that they don't actually see themselves accurately. Their visual perceptions are off.

Therapy models such as family-based therapy, cognitive-behavioral treatments, and drug treatments seem to help shift perception along with changes in habits.

Anorexia and Perception of Self

This section discusses how anorexic individuals perceive themselves and how changing habits can rewire their circuits.

Anorexia and Perception of Self

Anorexic individuals change their behavior by assessing foods and environments related to food. They start putting on healthy weight, doing exercises that allow them to put on healthy weight, and avoiding extreme exercises.

Trying to tell someone they are thin and need to eat does not work because anorexic individuals do not see themselves the same way others see them. Changing habits can rewire those circuits.

Anorexic individuals' brains are completely off as it relates to visual perceptions in particular.

Bulimia, Binge Eating Disorder, and Clinical Criteria

This section discusses bulimia, binge eating disorder, clinical criteria for diagnosis, and hallmark features.

Bulimia

Bulimia is overeating followed by purging typically through self-induced vomiting or ingestion of laxatives.

People with bulimia ingest far more calories than they need within a two-hour period. They override mechanical signals from the body that they're full.

Binge Eating Disorder

Binge eating disorder has a lot of the same features as bulimia but typically no purging.

People with binge eating disorder are unable to control their eating. They are driven from the inside without question by way of neurocircuitry.

Clinical Criteria

If somebody has one binge once a year, it does not make them bulimic. If somebody is doing this at least once a month over a period of anywhere from two to three months, then it likely would qualify.

People who have cheat days and eat whatever they want and in whatever volumes may have something like binge eating disorder.

The Neurocircuitry of Bulimia and Binge Eating Disorder

This section discusses the neurocircuitry involved in bulimia and binge eating disorder.

Neurocircuitry

People with bulimia or binge eating disorder are driven from the inside to ingest far more food than they need by way of neurocircuitry.

All homeostatic signals are being overridden, all signals from the body, leptin, insulin, glucose, etc., have cosmically sky high levels.

Hypotheses

There are many hypotheses about why bulimia and binge eating disorder arise. One hypothesis is the thyroid hormone hypothesis.

Thyroid Hormone and Growth Hormone

This section discusses the use of energy in converting it to different tissues of the body, cartilage bone, fat, and muscle. It also mentions that thyroid hormone can be depleted at other phases of the binge-purge cycle.

Thyroid Hormone

Thyroid hormone is involved in converting energy to different tissues such as cartilage bone, fat, and muscle.

Depletion of thyroid hormone can occur at other phases of the binge-purge cycle.

Terrible Things That Happen with Binge-Purge Cycle

This section highlights some terrible things that happen with the binge-purge cycle.

Terrible Things

Vomiting itself and use of laxatives can cause severe disruption to the mucosal lining of the digestive tract.

The gut microbiome can be severely disrupted by bulimia.

Ulceration of the esophagus can occur due to bulimia.

Hallmark Feature of Bulimia

This section discusses how lack of inhibitory control distinguishes bulimia from anorexia.

Lack of Inhibitory Control

A lack of inhibitory control is a hallmark feature that distinguishes bulimia from anorexia.

Bulimics are hyper impulsive and have other types of impulse behaviors.

Satiety is a general issue with impulse control for bulimics.

Treatments for Bulimia and Binge Eating Disorder

This section discusses the treatments for bulimia and binge eating disorder.

Treatments

Drugs that increase serotonin, such as fluoxetine (Prozac) and Paxil, can be effective in treating bulimia.

Some drugs used to treat attention deficit hyperactivity disorder (ADHD), such as Adderall and Vyvanse, can also be used to treat bulimia and binge eating disorder.

Lack of Prefrontal Control

This section discusses how lack of prefrontal control is related to impulsivity in bulimics.

Lack of Prefrontal Control

Impulsivity is an issue with bulimics due to a lack of prefrontal control.

Top-down control involves the prefrontal cortex suppressing the activity of deeper limbic and hypothalamic circuitry.

Frontotemporal dementia due to aging or head injuries can cause a lack of prefrontal control.

Treating Binge Eating Disorder

This section discusses the use of drugs and deep brain stimulation to treat binge eating disorder.

Drugs for Treating Binge Eating Disorder

Certain drugs, such as Wellbutrin (bupropion), can be effective in treating certain types of binge-eating disorder.

Wellbutrin is an antidepressant that increases dopamine and norepinephrine levels and is also used to promote smoking cessation.

Consultation with a psychiatrist is necessary to obtain prescription drugs for treating binge-eating disorder.

Deep Brain Stimulation for Treating Binge Eating Disorder

Deep brain stimulation has been explored as a new treatment approach for binge-eating disorder.

The nucleus accumbens, an area of the brain associated with dopamine release and reward pathways, plays a crucial role in motivated behaviors such as feeding and drug relay behavior.

Delta oscillations in the nucleus accumbens are associated with food reward in both mice and humans, creating a perception that food is hyper-rewarding.

Targeted deep brain stimulation can offset some of these activity patterns that lead to elevated sense of reward from food and binge eating.

Deep brain stimulation involves placing a wire down into an area of the brain that allows the individual to stimulate a particular brain area to offset some of these activity patterns.

Potential Benefits of Deep Brain Stimulation

While invasive, deep brain stimulation appears to be an effective treatment for people suffering from binge-eating disorder who are obese to the point where their health is greatly at risk.

Obesity causes all sorts of shifts in the dialogue between the brain and body, including disruptions to leptin signaling, which should shut down the desire to eat but is not functioning properly in obese individuals.

Understanding Eating Disorders

In this section, the speaker discusses how eating disorders are not simply a matter of self-control and describes the underlying biological mechanisms that contribute to anorexia, bulimia, and binge eating disorder.

Eating Disorders Are Not Simply a Matter of Self-Control

Eating disorders are not just a matter of self-control.

Anorexia is a disruption in habit and a coupling of unhealthy habits to the reward pathway.

Bulimia and binge eating disorder are caused by something deep within neural circuitry that makes food hyper-attractive.

Biological Mechanisms Underlying Eating Disorders

The break is off for those with bulimia, making it difficult for them to stop gorging themselves on food.

Deep brain stimulation can provide relief for patients with bulimia and lead to identification of receptors present in brain areas involved in the disorder.

Behavioral interventions coupled with drug-based interventions are more effective than either one alone for treating bulimia.

Anorexics feel great about restricting their food intake while those with bulimia feel terrible about gorging themselves on food.

Conclusion

These topics are heavy and difficult to talk about but understanding the biology behind eating disorders can help us develop empathy for those who suffer from them.

What is a Healthy Relationship to Food?

In this section, Dr. Rhonda Patrick discusses what constitutes a healthy relationship with food and how it varies from person to person.

Defining a Healthy Relationship with Food

A healthy relationship with food is subjective and varies from person to person.

Some people may find certain foods triggering while others may not.

It's important to be aware that some individuals may find the idea of eating animal-based foods repulsive.

For some people, food can be stressful based on personal history or general anxiety around food.

Managing Eating Anxiety

Approaching food can increase levels of anxiety in our brains.

Developing methods to calm oneself in the presence of any anxiety or fear-inducing stimulus can be beneficial.

Mindfulness meditation and physiological techniques like inhaling through the nose and long exhales can help manage eating-related anxiety disorders.

The Nuances of Nutrition

No topic is more complicated and nuanced than food and nutrition.

We should all ask ourselves what healthy eating means for us personally, so we can enjoy food without being neurotic or compulsive about it.

Focusing on extremes of food-related behaviors that qualify as genuine disorders is important because they are serious health concerns.

Body Dysmorphia and Social Media

In this section, the speaker discusses body dysmorphia and its relationship with social media. He talks about how it is not a new phenomenon and how it is related to plastic surgery, steroid abuse, diet, drug abuse, and other factors.

Body Dysmorphia Related to Social Media

The speaker mentions that there are more people dying from automobile accidents than from eating disorders.

Plastic surgery can be a form of body dysmorphia.

Exercise-related and plastic surgery-related body dysmorphia deserve their own episode.

There has been an increase in the portrayal of muscular men and curvy women in media leading to hypertrophy of the imagery.

This shift in portrayal has led to various types of disorders related to body dysmorphia.

Coping with Subconscious Homeostatic Processes

The speaker introduces a model for thinking about behaviors and perceptions: one box for what you think, one box for what you do, and something intervening between those two boxes.

Coping with subconscious homeostatic processes can lead to doing things that are not good for us or others.

Knowledge of knowledge can allow us to do better over time through neuroplasticity.

Support for the Podcast

The speaker encourages listeners to subscribe to their YouTube channel, leave comments/feedback/suggestions on YouTube or Apple/Spotify podcasts, check out sponsors mentioned at the beginning of the podcast as a way to support them, make tax-deductible donations on hubermanlab.stanford.edu, and check out supplements on Thorne.com/u/huberman.