Healthy Eating & Eating Disorders - Anorexia, Bulimia, Binging | Huberman Lab Podcast #36

Aug 18, 2023

Healthy Eating & Eating Disorders - Anorexia, Bulimia, Binging | Huberman Lab Podcast #36

In this episode, I discuss what drives hunger and satiety, and the role our brain, stomach, fat and hormones play in regulating hunger and turning off the desire to eat more. I also address how protein is assimilated better early in the day than it is later in the day, and why those using intermittent fasting might want to shift their feeding window to earlier in the day.

Then I delve into the topic of disorders of eating: Anorexia Nervosa, where people starve themselves and Bulimia Nervosa where people binge and purge their food. I discuss some common myths about Anorexia such as the role of media images increasing the rates of anorexia and the myth of the “perfectionist” anorexic. I also review the symptoms, and the brain and chemical systems disrupted in this condition. I explain how anorexics become hyperaware of the fat content of foods and develop reflexive habits of fat-hyperawareness. Then I discuss the most effective treatments ranging from family-based models to those that target the habitual nature of low-fat/calorie food choices. I also discuss new more experimental clinical trials on MDMA, Psilocybin and Ibogaine for Anorexia, and both their promise and risks.

I review the latest work on binge eating disorder and brain stimulation, drug treatments and thyroid disruption in Bulimia and why the treatments for Bulimia are so similar to those for ADHD. Finally, I discuss “cheat days,” body dysmorphia and the growing list of novel forms of eating disorders start to finish. As always, science and science-based tools are discussed.

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Links:
Ingesting Protein in the Morning Supports Muscle Maintenance \u0026 Growth: https://bit.ly/3DPlms7

Studies Using Virtual Reality to Explore Eating \u0026 Hunger \u0026 Body Image:
https://bit.ly/3BGaDya

https://bit.ly/2WWGRq8

Timestamps:
00:00:00 Introduction: Fasting, \u0026 Defining Healthy Eating
00:08:55 Morning Protein Is Important
00:22:04 Sponsors
00:26:29 Defining \u0026 Diagnosing Eating Disorders
00:29:00 Anorexia Nervosa (Overview \u0026 Myths)
00:33:44 Bulimia (Overview \u0026 Myths)
00:37:35 Binge Eating Disorders, EDNOS, OSFEDS, Pica
00:39:44 What is Hunger? What is Satiety?
00:42:00 Neuronal \u0026 Hormonal “Accelerators \u0026 Brakes” on Eating
00:46:17 Fat, Leptin \u0026 Fertility \u0026 Metabolic Dysfunctions in Obesity
00:50:30 Why We Overeat
00:55:30 Homeostasis \u0026 Reward Systems/Decisions
00:59:58 Anorexia
01:04:28 The Cholesterol Paradox
01:06:13 Psychological vs. Biological/Genetic Factors in Anorexia
01:09:44 Chemical Imbalances, Serotonergic Treatments
01:12:56 Altered Habits \u0026 Rewards in Anorexia: Hyperacuity for Fat Content
01:18:28 Brain Areas for Reward Based Decision Making vs. Habits
01:24:06 Habit-Reward Circuits Are Flipped in Anorexics: Reward for Deprivation
01:28:30 How Do You Break a Habit?
01:33:23 Family Based Models, Cognitive Behavioral Therapy
01:35:39 MDMA, Psilocybin, Clinical Trials, Ibogaine
01:40:35 Anabolic vs. Catabolic Exercise, Spontaneous Movements, NEAT
01:43:23 Distorted Self Image in Anorexia
01:47:54 Bulimia \u0026 Binge-Eating, “Cheat Days”, Thyroid Hormone
01:53:05 Inhibitory Control, Impulsivity, Adderall, Wellbutrin
01:58:00 Direct Brain Stimulation: Nucleus Accumbens
02:04:28 Anorexia/Reward. vs Bulimia/Binging
02:05:45 Healthy Eating Revisited
02:10:55 Synthesis, Body Dysmorphias
02:14:15 Support: Podcast, \u0026 Research Studies

Please note that The Huberman Lab Podcast is distinct from Dr. Huberman’s teaching and research roles at Stanford University School of Medicine. The information provided in this show is not medical advice, nor should it be taken or applied as a replacement for medical advice. The Huberman Lab Podcast, its employees, guests and affiliates assume no liability for the application of the information discussed.

Title Card Photo Credit: Mike Blabac - https://www.blabacphoto.com

Content

0.36 -> - [Andrew Huberman] Welcome to the Huberman Lab Podcast,

2.3 -> where we discuss science

3.71 -> and science-based tools for everyday life.

9.2 -> - I'm Andrew Huberman.

10.26 -> And I'm a Professor of Neurobiology and Ophthalmology

12.98 -> at Stanford School of Medicine.

15.21 -> Today, we are going to talk all about healthy

17.55 -> and disordered eating.

19.28 -> And indeed, we are going to talk

20.52 -> about clinical eating disorders,

22.53 -> such as anorexia, bulimia, and binge eating disorder,

27.15 -> as well as some other related eating disorders.

30.31 -> However, before we get into this material,

32.41 -> I want to emphasize that today's discussion will include

36.09 -> what it is to have a healthy relationship with food.

39.38 -> We're going to talk about metabolism.

41.61 -> We're going to talk about how eating frequency

44.43 -> and what one eats influences things like appetite

48.7 -> and satiety, as well as whether or not we have a healthy,

52.41 -> psychological relationship to food and our body weight

56.43 -> and so-called body composition, the ratio of muscle to fat,

60.44 -> to bone, et cetera.

62.65 -> So, as we march into this conversation,

65.08 -> I'd like to share with you some interesting

66.682 -> and what I believe are important findings in the realm

69.84 -> of nutrition and human behavior.

73.17 -> I know these days,

74.4 -> many people are excited about or curious

76.94 -> about so-called intermittent fasting,

79.73 -> intermittent fasting is as the name implies,

82.76 -> simply restricting one's feeding behavior,

85.97 -> eating to a particular phase of the 24 hour

89.39 -> or so-called circadian cycle.

92.25 -> Other forms of intermittent fasting involve not eating

95.26 -> for extended periods of time for an entire days,

98.33 -> or some people will extend to two days

100.21 -> or three days typically.

101.657 -> And hopefully they will drink water during those times,

105.62 -> sometimes referred to as water fasting,

108.34 -> which means that they are ingesting fluids.

111.23 -> And hopefully they are ingesting electrolytes such as salt,

113.83 -> potassium and magnesium as well,

116.04 -> because well one can survive for some period

119.79 -> of time without ingesting calories,

122.77 -> it is extremely important to continue to ingest plenty

125.88 -> of fluids and electrolytes.

128.04 -> And the reason for that is that the neurons of your brain

130.94 -> and body that control your movements, your thoughts,

133.47 -> clarity of thinking in general, et cetera,

136.97 -> is critically dependent on the presence of adequate levels

140.42 -> of sodium, potassium and magnesium, the electrolytes.

143.79 -> And that's because neurons can only be electrically active

146.7 -> by way of movement of particular ions,

149.5 -> which include things like sodium potassium and magnesium.

152.37 -> So, without those,

153.6 -> you can't think, you can't function and it actually

156.3 -> can be quite dangerous.

157.64 -> So, why all the excitement about intermittent fasting?

160.9 -> Well, a lot of the excitement relates to work that was done

164.17 -> by a former colleague of mine,

165.73 -> down at the Salk Institute for Biological Studies

167.95 -> in San Diego, named Satchin Panda,

170.52 -> Satchin's lab identified some very important

173.761 -> and impactful health benefits of restricting

177.11 -> one's feeding window to particular within the 24 hour cycle,

181.33 -> or even to having extended fasts that go for a day

182.525 -> or two days, or maybe even three days.

188.04 -> What they saw was an improvement

190.08 -> in liver enzymes and improvement in insulin sensitivity,

191.999 -> which is something that is good.

196.46 -> It means that you can utilize the calories

199.16 -> and the blood sugar that you happen to have,

202.15 -> being insulin insensitive is not good,

205.01 -> and is actually a form of diabetes.

208.16 -> What Satchin's lab and subsequently other labs showed,

212.08 -> was that restricting one's feeding window to anywhere

214.64 -> from four to eight or even 12 hours

217.9 -> during each 24 hour cycle was beneficial in mice.

221.48 -> And some studies in humans have also shown

223.71 -> that it can be beneficial for various health parameters.

227.23 -> However, the excitement about intermittent fasting seems

231.49 -> to be related to the foundational truth about metabolism

236.902 -> and weight loss and weight maintenance and weight gain,

240.41 -> which is that regardless of whether or not you intermittent

244.07 -> fast or whether or not you eat small meals all day long,

246.92 -> or you eat one meal in the evening and snack up until then,

250.71 -> it really doesn't matter in the sense that the calories

255.76 -> that you ingest from whatever source,

258.58 -> are going to be filtered through the calories that you burn,

264.01 -> by way of exercise, basal metabolic rate,

266.46 -> which is just the calories that you happen to burn,

268.78 -> just being alive and thinking and breathing

271.08 -> and your heart beating, et cetera.

272.75 -> And the reason why many people will prefer intermittent

276.24 -> fasting to other forms of let's just call it what it is diet

280.28 -> or nutritional framework is that many people find it easier

285.05 -> to not eat, then to limit their portion size.

289.06 -> And here I'm not talking necessarily about eating disorders.

291.94 -> I'm talking about the general population.

293.93 -> So, I think that's one reason why there's so much excitement

297.574 -> about intermittent fasting.

298.49 -> Now, within the context of intermittent fasting

301.65 -> on a circadian timescale, once every 24 hours,

304.9 -> you generally find two categories of people,

308.038 -> people who prefer to not eat in the morning,

310.99 -> either because they are not hungry in the morning,

313.07 -> or because they find it relatively straightforward

315.81 -> to just drink things like coffee or water, et cetera,

320.13 -> and push their feeding window out to noon or 2:00 P.M.

324.14 -> or 3:00 P.M. and then they'll eat between,

325.74 -> say 1:00 P.M. and 8:00 P.M. or 9:00 P.M..

328.85 -> It depends on the individual.

331.24 -> Other groups of people find that they are very hungry

333.54 -> when they wake up in the morning,

334.86 -> they don't feel well if they don't eat breakfast.

337.12 -> And so they prefer to eat early in the day,

339.42 -> but then they limit their feeding window such that they cut

341.7 -> off their food intake or stop ingesting any calories

344.65 -> of any kind, somewhere around 5:00 P.M.

347.43 -> or 6:00 P.M., et cetera.

349.3 -> So, the duration of the feeding window

351.05 -> has not been broken down into the kind of nuanced type

354.83 -> of information that one would really want.

357 -> At least not in human studies saying,

358.61 -> well, a six hour feeding window

360.03 -> or an eight hour feeding window is ideal.

362.23 -> It really is going to vary based on lifestyle

364.37 -> and circumstances, for instance,

365.77 -> some families really want

367.76 -> to eat dinner together every night.

369.33 -> So, do you want to be the person that's sitting

371.21 -> there watching everybody eat?

372.44 -> Because you're fasting from 5:00 P.M. onwards?

375.45 -> I don't know.

376.283 -> That's an individual difference.

377.69 -> What you can start to identify, however,

379.62 -> is that people tend to fall into either one category.

381.98 -> The other people who prefer to skip eating in the morning

384.52 -> or people that prefer to,

386.18 -> or managed to skip eating in the evening.

388.23 -> And there has been no evidence thus far,

391.28 -> that one is better or worse,

392.82 -> at least in terms of weight loss

394.37 -> or overall health parameters.

396.49 -> Now, you can imagine that some people

398.41 -> might eat breakfast and dinner.

399.76 -> And indeed I have several many colleagues

402.12 -> in fact who just choose to skip lunch,

403.84 -> because they're busy during the day,

404.84 -> they eat breakfast and dinner, that doesn't afford the long,

408.27 -> fast associated with sleep.

411.09 -> What do I mean by that?

411.923 -> Well, if you went to sleep at 11:00 P.M.

413.81 -> and you wake up at 6:00 A.M.

415.87 -> by extending your fast until 1:00 P.M. in the afternoon,

419.26 -> you get quite a long period of no ingesting any calories.

422.88 -> Whereas when you don't eat during the middle of the day,

425.72 -> you are getting a fasting period.

427.22 -> That's probably anywhere from four to seven hours,

430.39 -> but it's not linked to the longer fasting period

432.992 -> of not eating while you are asleep, because most,

436.22 -> all people and I want to emphasize most,

438.14 -> do not eat while they are asleep.

440.22 -> But we are going to talk about any new disorder

442.41 -> that does exist, where people actually eat in their sleep.

446.21 -> I know it sounds pretty wild, but indeed it,

448.332 -> that eating disorder does exist.

451.68 -> And it has a very interesting underlying mechanism.

455.17 -> So, why are we talking about this?

456.68 -> And in particular, why are we talking about this during

459.87 -> an episode that includes a discussion

461.74 -> about eating disorders?

462.955 -> The reason is, nobody not the government, no nutritionists,

468.7 -> no individual, no matter how knowledgeable

471.97 -> they are about food and nutrition and food intake,

475.34 -> can define the best plan for eating for any one individual.

481.21 -> I'm going to repeat that.

482.06 -> Nobody knows what truly healthy eating is.

485.5 -> We only know the measurements we can take, liver enzymes,

488.87 -> blood lipid profiles, body weight, athletic performance,

493.12 -> mental performance, whether or not you're cranky all day,

496.14 -> whether or not you're feeling relaxed,

497.92 -> nobody knows how to define these.

499.43 -> And these have strong cultural and familial

503.72 -> and socio-societal influence.

507.23 -> So, if you hang out with people that intermittent fast all

509.96 -> day, that will seem normal.

511.47 -> If you spend time with people that have never heard

513.49 -> of intermittent fasting,

514.67 -> intermittent fasting is going to seem very abnormal.

517.82 -> Now we are going to talk about eating disorders

519.8 -> that really fall into the category

521.39 -> of clinically diagnosable eating disorders,

522.606 -> for which there's actually serious health hazards

525.848 -> and even the serious risk of death,

527.852 -> we will get to that topic.

532.85 -> But for the time being,

533.683 -> I want to emphasize a new set of findings

536.7 -> that I think many people will find interesting.

538.46 -> And at least we'll want to consider in light

540.67 -> of their current nutritional plan or pattern of eating,

544.35 -> whether or not you're intermittent fasting or not.

546.88 -> And I want to cue up an important framework

549.67 -> for the rest of the conversation on healthy

551.61 -> and disordered eating,

553.07 -> which includes an understanding of thinking, decision-making

559.02 -> and what we call homeostatic processes,

561.73 -> meaning regulation of things that are going on in our brain

565.809 -> and body and reward mechanisms.

566.642 -> So, I'm going to return to that in a moment,

568.14 -> but first I want to share with you these new findings

570.68 -> that were just published in the Journal Cell Reports,

573.621 -> a Cell Press Journal, excellent journal.

575.05 -> This was a study that was performed both in mice

577.96 -> and it included a crossover study with a human population.

582.44 -> The human population was women,

584.63 -> but it relates to a previous study that was also carried

587.47 -> out in men.

588.65 -> I'm going to simplify this study.

589.85 -> We will provide a link to the full study so you can explore

592.44 -> it in more detail.

593.36 -> And if you're really excited about the results,

595.19 -> I would encourage you to explore some of the references

598.16 -> within that paper as well.

601.44 -> What was the study?

602.8 -> The study looked at giving mice or humans, two meals.

608.28 -> And explored whether or not putting those meals early

611.25 -> in the day or late in the day,

614.41 -> had an impact on muscle hypertrophy,

617.62 -> muscle growth and overall protein synthesis of muscle.

621.44 -> So, when we eat, the amino acids from various foods

624.85 -> are broken down and synthesized

626.39 -> into different types of tissues.

627.64 -> They can be utilized for energy,

630.12 -> burned up for moving about and thinking et cetera,

632.72 -> or it can be synthesize.

634.37 -> Those amino acids can be synthesized into skeletal muscle.

638.01 -> The sorts of skeletal muscles that allow you

639.49 -> to move your limbs.

640.772 -> This study explored how protein intake,

646.58 -> which included what are called branch chain amino acids,

650.54 -> and amino acids, like leucine,

652.26 -> which are important for muscle protein synthesis.

654.4 -> Explored whether or not emphasizing

657.92 -> or skewing the protein intake toward early day

662.87 -> or late day was better in terms of muscle hypertrophy.

666.92 -> And they also looked at some parameters of strength,

668.97 -> like grip strength.

670.87 -> Now mice are nocturnal.

672.94 -> So, before you say wait, mice are nocturnal,

674.82 -> how did they look during the day?

675.86 -> And it's completely,

676.693 -> it doesn't apply because it's in mice.

678.38 -> Of course they knew that.

680.29 -> And they looked during the mice's active phase

684.33 -> of their circadian cycle, which corresponds to our day.

686.88 -> And in humans, they looked at whether or not eating

689.17 -> most of one's protein early in the day,

692.46 -> was better than if the protein intake

694.45 -> and the sprint chain amino acids

696.22 -> were placed later in the day.

698.2 -> And yes, they had the mice do resistance training.

701.26 -> They did that by emphasizing overload to one limb

705.89 -> of the mouse.

707 -> And that actually generates hypertrophy.

708.57 -> It's a form of resistance training in mice.

710.98 -> So, they don't have them weight training.

712.52 -> They weren't doing curls and dips and squats

715.03 -> and things of that sort.

716 -> They were moving their own body weight,

717.35 -> but they skewed that distribution of body weight

719.7 -> by restricting a limb and forcing them to use one limb

723.959 -> that did indeed grow in response to that.

725.57 -> And then in humans,

726.51 -> there was an exploration of grip strength.

728.47 -> And then with resistance training that was also carried

731.29 -> out through a peripheral study.

734.282 -> Basically the takeaway from this study was that mice

736.97 -> and humans can utilize amino acids that are ingested early

742.12 -> in the day,

742.98 -> better than they can utilize amino acids ingested later

746.6 -> in the day in particular toward muscle hypertrophy

751.07 -> and growth or maintenance of muscle,

754.4 -> which for those of you that aren't interested

756.22 -> in much muscle hypertrophy that aren't trying

757.97 -> to grow your muscles.

759.06 -> I've talked before in the episode on building strength

762.1 -> and hypertrophy, that maintaining muscle,

765.62 -> regardless of one's athletic prowess,

767.87 -> regardless of one's age is extremely important

770.612 -> because loss of skeletal muscle

773.28 -> is one of the major causes of injury.

775.46 -> As we age.

776.293 -> It's one of the major causes,

777.126 -> believe it or not, of cognitive and metabolic deficits

781.9 -> as we age.

782.733 -> So, maintaining muscle is important.

784.83 -> Building muscle might be important to some of you,

787.401 -> but what they found was ingesting protein early in the day.

790.35 -> And these amino acids early in the day,

792.233 -> led to more muscle hypertrophy than if the majority

795.73 -> of amino acids and proteins were ingested late in the day.

798.51 -> So, this translates to intermittent fasting,

800.814 -> such that if you are interested in muscle hypertrophy,

803.91 -> you might, and I want to emphasize,

805.1 -> might consider making sure that you're getting sufficient

809.04 -> protein intake early in the day.

811.62 -> What sources of protein you use,

813.12 -> is going to be highly individual.

814.41 -> Some of you are meat eaters.

815.71 -> Some of you don't eat red meat.

817.14 -> Some of you eat chicken and fish and eggs.

818.678 -> Some of you don't, some of you are vegans.

820.95 -> It has been shown that the amino acid leucine is vital

824.45 -> for the cell growth process,

826.03 -> including muscle growth, because of its relationship

828.41 -> to the so-called mTOR pathway,

830.01 -> mammalian target of rapamycin.

832.32 -> We can talk about that more if you like in a future episode,

836.39 -> this means that if you're somebody who wants to maintain

839.13 -> or increase the amount of muscle mass that you have,

843.49 -> ingesting a high protein meal early in the day ought

845.94 -> to be beneficial for that.

847.94 -> Does it mean that you should not eat protein

849.98 -> in the afternoon and evening?

852 -> No.

852.833 -> I think a lot of people might've misinterpreted this study

855.66 -> and I don't want that to happen.

857.173 -> This is only pointing out the fact

859.93 -> that ingesting sufficient quality amino acids,

863.33 -> including leucine, early in the day can be beneficial

867.78 -> for maintenance and growth of muscle tissue.

870.93 -> It does not say that you should avoid protein later

874.05 -> in the day.

875.03 -> Now for you intermittent fasters, this could be relevant.

878.54 -> I, for instance,

879.373 -> with somebody who for a very long time skipped breakfast,

882.65 -> my first meal of the day would be in the early afternoon,

886.05 -> mostly protein and salad, in my case, animal protein.

888.89 -> 'Cause that's in alignment with my values.

891.81 -> Then in the evening I would eat pasta,

894.6 -> vegetables, et cetera.

895.48 -> I might have some protein,

896.41 -> some small piece of fish or chicken or something like that,

898.4 -> but I didn't really emphasize that.

900.7 -> On the basis of these results.

902.24 -> I am experimenting with.

903.6 -> I want to emphasize experimenting with,

905.2 -> I haven't completely tossed out my old protocol,

908.78 -> but I'm experimenting with eating proteins early in the day

912.74 -> and eating lunch.

914.06 -> And then dinner might be light supper of some sort,

917.65 -> but not so much protein later in the evening.

920.55 -> Again, if you want to eat six meals a day,

922.24 -> you want to eat round the clock.

923.3 -> I'm not going to stop you.

924.17 -> I'm not telling anybody what to do.

925.45 -> As I mentioned earlier,

926.283 -> nobody knows exactly how to eat for one's particular goals.

929.37 -> But this study was really interesting,

930.83 -> because it really did show that we can utilize

933.61 -> the proteins that are ingested early in the day,

935.75 -> better than we can utilize the proteins that are ingested

939.645 -> later in the day.

940.478 -> And of course there will be factors that can shift that.

942.9 -> For instance, if you work out very hard

944.56 -> with resistance training later in the day,

946.43 -> resistance training is known to increase protein synthesis.

949.295 -> So, it stands to reason that ingesting amino acids

952.66 -> after that training would be beneficial.

954.292 -> However, in this study,

956.12 -> it did not seem to matter when the resistance training fell

958.89 -> within the 24 hour schedule.

961.72 -> The morning ingestion or early day ingestion

964.46 -> of amino acids seemed to be beneficial.

966.45 -> How early?

967.283 -> Between the hours of about 5:00 A.M.

970.845 -> and 10:00 A.M. for humans.

972.614 -> Now just a bit of mechanism to explain why this happens.

975.386 -> So, why would it be that ingesting protein early in the day

978.642 -> would lead to more synthesis of muscle

981.15 -> than ingesting protein later in the day?

983.277 -> And the reason it turns out is related

985.81 -> to the circadian clock mechanism

987.97 -> that is present in all cells, including muscle cells.

990.584 -> So, muscles have fibers.

992.11 -> I think most people are aware of that,

993.42 -> that your muscles are not just one big blob of tissue.

996.11 -> A lot of these little fibers that contract.

998.128 -> Within those fibers, however, there are cells with nuclei.

1001.092 -> Those nuclei contained DNA.

1006.76 -> DNA is transcribed into RNA.

1008.67 -> RNA is translated into proteins.

1012.85 -> The DNA of your cells,

1014.5 -> including these muscle cells

1015.84 -> are under strong circadian regulation.

1018.92 -> Each one has a pattern of gene expression that is different

1022.6 -> at different times during the 24 hour cycle,

1025.06 -> this is an unescapable reality of all cells in your body,

1030.01 -> right from your hair cells to your brain cells,

1032.18 -> to your retinal cells, to your toe on both feet.

1036.25 -> These cells make a gene called, BMAL, BMAL, B-M-A-L

1040.97 -> is a clock gene.

1042.21 -> And the expression of this clock gene varies

1044.49 -> across the 24 hour cycle,

1046.43 -> and proteins that are downstream

1048.64 -> of this BMAL gene influence protein synthesis.

1053.2 -> The circadian regulation of this BMAL gene turns

1055.7 -> out to be vitally important

1056.683 -> for this protein synthesis mechanism.

1060.24 -> How do we know that?

1061.1 -> Well, in this particular study,

1062.67 -> because they had a mouse that lacked BMAL,

1067.19 -> the gene was knocked out, they had bunch of these mice.

1070.86 -> They were able to explore whether or not this early day

1073.4 -> feeding effect was present or absent

1076.82 -> in these mice that lack the gene BMAL.

1079.22 -> And indeed it was absent.

1080.58 -> In other words,

1081.6 -> the effect of increased protein synthesis early in the day

1084.35 -> was eliminated in the absence of the BMAL gene.

1088.29 -> So, what this means is that when you wake up in the morning,

1090.79 -> assuming you're following a standard schedule

1092.82 -> of being asleep at night and awake during the day,

1095.63 -> your muscle cells are primed to incorporate amino acids

1099.08 -> and synthesize muscle,

1100.67 -> regardless of whether or not you weight trained

1102.42 -> the night before 8:00 P.M.,

1104.11 -> or you don't weight train at all,

1105.3 -> or you weight train afterwards or before.

1108.65 -> I said five to 10:00 P.M. is the sort of critical

1111.32 -> window for this increased protein synthesis.

1113.76 -> All this means is that if you are interested in maintaining

1116.229 -> or enhancing muscle tissue volume,

1120.13 -> that you might want to consider eating quality,

1123.84 -> protein and amino acids early in the day,

1127.33 -> you could train first.

1128.22 -> You could train after, you can not train at all.

1131.14 -> That's entirely different discussion.

1134.21 -> What is quality protein,

1135.77 -> well quality protein is going to be a protein

1137.69 -> that includes most of the essential amino acids.

1140.45 -> And in particular leucine.

1142.76 -> Now, there's a lot of debate as to whether

1144.77 -> or not you can get all the essential amino acids

1147.21 -> from a purely plant based diet

1148.67 -> or whether or not you need

1149.503 -> to ingest animal-based foods or not.

1152.41 -> The term quality protein

1154.33 -> has no strict scientific definition.

1156.345 -> Some people define quality protein as a protein

1160.31 -> that has a high essential amino acid to caloric ratio.

1164.89 -> Now, what that means is, a small piece of chicken

1168.05 -> or steak or eggs for instance,

1169.97 -> will have many essential amino acids

1172.7 -> with a low caloric content relative to say beans

1178.03 -> or plant-based food that can also get

1180.5 -> you essential amino acids,

1181.81 -> but it requires more calories to access

1184.48 -> those essential amino acids.

1187.12 -> Now that's that has many exceptions and nuances.

1190.48 -> And I for one, and perfectly respectful of the folks

1193.34 -> that just want to ingest plant-based foods in order to get

1196.67 -> their high quality protein.

1197.92 -> I think that actually can be done.

1199.85 -> One has to be careful and thoughtful in their choices

1202.61 -> about how to do that.

1203.66 -> So, this really isn't about animal based

1205.7 -> versus non-animal based foods.

1207.46 -> This is about getting quality amino acids early in the day

1211.28 -> from whatever foods are in alignment with your particular

1214.9 -> values in your particular eating plan.

1216.62 -> So, that's a lot of information,

1218.64 -> but the key takeaways are every cell in your muscles

1221.95 -> has a clock gene.

1223.36 -> The clock genes vary such that protein synthesis

1226.905 -> is greater early in the day than it is later in the day,

1230.46 -> such that in both mice and in humans,

1233.37 -> ingestion of quality proteins early in the day will be more

1238.13 -> so incorporated into muscle.

1239.7 -> Than the proteins that are ingested late in the day.

1242.33 -> And of course there are the caveats of if you're training

1246.19 -> hard late in the day,

1247.68 -> if you're adjusting your hormone status

1249.58 -> through whatever mechanism et cetera,

1251.605 -> protein synthesis can also be high later in the day.

1254.96 -> But for most people it's going to taper off due

1256.84 -> to this circadian BMAL gene related mechanism.

1260.51 -> Again, we will provide a link to the study

1262.82 -> and the other key takeaways were that nobody knows.

1266.17 -> Nobody can tell you what healthy feeding windows are,

1269.27 -> what the best feeding windows are.

1270.76 -> There's absolutely no information in that context,

1273.26 -> you talk to 10 nutritionists or academics or trainers

1278.67 -> or individuals about what healthy eating is,

1280.65 -> and you are going to get vastly different answers.

1282.94 -> And that's one of the reasons why I believe

1284.64 -> that the internet in particular social media,

1288.09 -> are so filled with contradictory opinions,

1290.83 -> but the calories in versus calories burned formula,

1295.65 -> is that more or less holy foundation of all things

1299.52 -> about nutrition, eating and weight.

1302.245 -> And as we transition today into the discussion

1303.58 -> about eating disorders,

1304.75 -> I'd like you to keep this in mind because for the treatment

1308.6 -> of eating disorders,

1309.64 -> it doesn't matter what psychological

1312.222 -> or early trauma based effects led to the eating disorder.

1316.61 -> If the person isn't adjusting their feeding behavior

1319.56 -> in a way that is going to ameliorate the symptoms

1322.07 -> of that disorder, which is ultimately the goal.

1324.91 -> Before we begin, I'd like to emphasize that this podcast

1327.44 -> is separate from my teaching and research roles at Stanford.

1330.36 -> It is however, part of my desire and effort

1332.54 -> to bring zero cost to consumer information about science

1335.21 -> and science related tools to the general public.

1338.14 -> In keeping with that theme,

1339.23 -> I'd like to thank the sponsors of today's podcast.

1342.2 -> Our first sponsor is Belcampo,

1344.82 -> Belcampo is a regenerative farm in Northern California

1347.49 -> that raises organic grass fed

1349.26 -> and finished certified humane meats.

1352.5 -> I don't eat a lot of meat, but I eat meat about once a day.

1353.547 -> That means a small piece of steak or chicken, et cetera,

1358.761 -> and usually a salad.

1360.95 -> I usually do that for breakfast or for lunch.

1362.828 -> And then in the evening I tend to follow a more

1366.31 -> or less vegetarian diet.

1367.42 -> I tend to eat pastas and vegetables and things of that sort.

1372.02 -> Well I don't eat a lot of meat.

1373.14 -> It's important that the meat that I eat be a very high

1376.158 -> quality and that I am certain that the animals were raised

1378.74 -> and treated humanely up until the point of slaughter.

1382.1 -> Belcampo's animals, graze on open pastures

1384.17 -> and seasonal grasses, their entire lives resulting

1386.65 -> in meat that's higher in nutrients and healthy fats.

1389.742 -> It also results in healthy happy cows.

1392.26 -> Often talk about how important omega-3 fatty acids are.

1396.06 -> They've been shown to be important for regulating mood,

1398.84 -> for the microbiome,

1400.24 -> for restricting inflammation in the brain

1401.94 -> and elsewhere in the body.

1403.37 -> Belcampo's meats are known to be high in omega threes.

1406.16 -> And given that the meat is grass fed and grass finished,

1409.37 -> that combines all the features of the nutrition

1412.77 -> and the animal wellbeing that I want to see

1415.59 -> for any meat that I ingest.

1417.97 -> If you'd like to try Belcampo, first-time customers can get

1420.39 -> 20% off by going to belcampo.com/huberman

1424.14 -> and using the code huberman@checkout,

1426.4 -> that's belcampo.com/huberman for 20% off.

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1430.63 -> Today's podcast is also brought to us by Headspace.

1433.67 -> Headspace is a meditation app.

1435.04 -> That's backed by 25 published studies

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1441.35 -> I've been meditating for a very long time.

1444.691 -> Although I admit I meditate on and off,

1445.97 -> meaning I'll go a few weeks or months meditating regularly.

1449.04 -> And then I tend to stop.

1451.01 -> A few years ago, I got into a regular meditation practice

1453.97 -> because I started using Headspace meditation app.

1457.32 -> The thing I really like about their meditation app

1459.14 -> is it has meditations of different durations.

1461.36 -> So, sometimes I'll just meditate for three minutes

1463.51 -> or five minutes,

1464.343 -> or ideally I'm doing two 20 minute sessions per day,

1467.08 -> but I confess I don't always manage that,

1469.33 -> but they have a ton of different meditations

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1473.22 -> to tailor your meditation practice

1475.09 -> to your particular schedule.

1477.1 -> And there are now a plethora of studies showing the benefits

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1494.7 -> So, again, if you're interested,

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1499.1 -> Today's episode is also brought to us by Athletic Greens.

1503.142 -> Athletic Greens is a vitamin mineral probiotic drink,

1505.18 -> and it's one that I've been drinking since 2012.

1508.48 -> The reason I started drinking Athletic Greens and the reason

1512.006 -> I still take Athletic Greens is that it really helps me

1514.508 -> cover all of my nutritional basis with respect to vitamins

1516.03 -> and minerals and probiotics.

1517.359 -> And we now know that a healthy gut microbiome

1521.45 -> is supported by probiotics.

1523.17 -> And for me,

1524.55 -> Athletic Greens is the best way to get those probiotics.

1527.21 -> I also ingest some fermented foods,

1528.81 -> but by ingesting Athletic Greens,

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1535.35 -> I genuinely feel like I have more energy

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1538.47 -> And I happen to really like the way it tastes.

1540.32 -> I mix mine with some water and some lemon juice.

1542.22 -> And in doing that, I'm certain to get all my nutritional

1544.85 -> basis covered and the probiotics support

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1548.53 -> which is important for mood,

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1571.92 -> vitamin D3 and K2 have been shown to be important

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1582.42 -> So, go to athleticgreens.com/huberman

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1589.67 -> So, let's talk about eating disorders.

1592.755 -> And as we do that, I want to emphasize again,

1594.12 -> that nobody can really define what healthy eating is,

1597.41 -> with a single protocol.

1598.66 -> However, there is some general agreement

1601.554 -> about what unhealthy and disordered eating is.

1604.37 -> There are clear criteria in the psychiatric

1606.82 -> and psychological communities to define things like anorexia

1611.42 -> bulimia, binge eating disorder,

1613.1 -> all of which we will talk about,

1614.83 -> but as we have that discussion,

1616.04 -> I want to emphasize that self-diagnosis

1619.58 -> can be both a terrific, but also a very precarious thing.

1623.95 -> We talked about this a little bit in the episode

1625.7 -> about depression, there's always a temptation as one learns

1629.59 -> about the symptomology of a given disorder.

1631.86 -> It doesn't really matter what the disorder is,

1634.19 -> to ask the question.

1635.023 -> Well, do I have that?

1636.26 -> Does so-and-so that I know have that, ah,

1638.006 -> I see this sort of behavior or that pattern of thinking.

1640.724 -> In that individual, it's tempting to diagnose them

1644.687 -> and or ourselves as either having or not

1647.18 -> having a particular disorder.

1648.49 -> However, diagnoses really need to be carried out by people

1653.35 -> who are trained in that particular field,

1656.38 -> and that have deep expertise in recognizing

1658.62 -> the symptomology, including some

1660.46 -> of the more subtle symptomology of eating disorders.

1663.36 -> So, if any of the symptoms resonate with you,

1667.72 -> by way of you thinking

1669.35 -> that you have this particular disorder or someone that,

1671.18 -> you know, has this disorder, I would take that seriously,

1675 -> but I would take that information

1676.76 -> to a qualified healthcare professional that could diagnose

1680.73 -> or rule out any of these possible disorders.

1683.43 -> I say that not to protect us,

1684.843 -> but to protect you, because information is valuable.

1688.38 -> And I do believe that knowledge of knowledge

1690.08 -> can be very valuable in navigating any topic

1692.84 -> and improving our thoughts and behaviors around that topic.

1695.324 -> But one doesn't want to, or I should say,

1698.84 -> one, shouldn't start to self-diagnose simply on the basis

1702.07 -> of information without running that through the filter

1704.97 -> of a qualified professional.

1706.75 -> So, what is an eating disorder?

1708.99 -> Well, we have to take a step back,

1711.243 -> and confess to the fact that every society, every culture,

1715.69 -> every family, and every individual

1717.7 -> has a different relationship to food,

1720.35 -> eating disorders, however, have particular criteria

1723.78 -> that allow us to define them and to think

1726.75 -> about different modes of treatment.

1729.22 -> As it relates to the particular symptoms and particular,

1733.38 -> the psychological and biological symptoms

1735.65 -> of those disorders.

1736.483 -> Now that's a mouthful, no pun intended.

1738.329 -> What are the major eating disorders?

1742.24 -> Anorexia nervosa, most commonly referred to as anorexia

1746.66 -> is perhaps the most prevalent and the most dangerous

1751.41 -> of all eating disorders.

1753.13 -> In fact, anorexia is the most dangerous psychiatric disorder

1757.31 -> of all, even more than depression.

1761.15 -> The probability of death for untreated anorexia

1764.65 -> is very high, and sadly the prevalence

1767.97 -> of anorexia is very high.

1769.93 -> So, what is anorexia and how prevalent is it?

1774.877 -> Anorexia, if you look it up online or you talk

1776.14 -> to a qualified professional, is essentially a failure

1778.91 -> to eat enough, to maintain a healthy weight.

1782.32 -> You can see all sorts of very troubling symptoms of somebody

1786.03 -> who's been anorexic for some period of time,

1789.51 -> a general loss of muscle mass because they're ingesting

1793.54 -> fewer calories than they burn.

1795.58 -> Muscle is very metabolically active.

1797.47 -> They tend to lose a lot of muscle mass.

1799.89 -> They will have a low heart rate.

1802.06 -> This is the body and brain's attempt to lower energy output.

1806.67 -> They will have low blood pressure.

1808.29 -> They'll sometimes have symptoms like fainting.

1810.95 -> They will have sometimes even hair growth on the face,

1815.22 -> something called lanugo,

1816.85 -> which is essentially the body's attempt

1819.01 -> to insulate the body because of loss of body heat.

1822.56 -> When you're that thin.

1825.787 -> Loss of bone density,

1826.9 -> osteoporosis, loss of periods in girls and women,

1831.88 -> and all sorts of disrupted gut and immune functions.

1837.41 -> So, there are just tons of terrible symptoms

1840.04 -> of anorexia that really placed the anorexic

1842.73 -> into a very risky state, which is why mortality

1847.81 -> from anorexia gone untreated is extremely high.

1851.82 -> Now, one of the misconceptions about anorexia,

1855.7 -> is that it stems from an overemphasis on perfectionism,

1860.09 -> or that because of all the images in social media

1864.31 -> and in advertising of extremely thin and fit

1867.75 -> or muscular people that individuals are looking

1870.76 -> at themselves and comparing themselves to those images

1874.1 -> and thinking that they don't match up

1875.63 -> and developing anorexia,

1876.838 -> that turns out to not be the case.

1881.16 -> If you look at the prevalence or the rates of anorexia,

1884.92 -> in the last 10 years or 20 years,

1887.27 -> and you compare that to when anorexia was first identified,

1890.75 -> which was in the 1600s, and perhaps even earlier,

1894.14 -> what you find is that rates of anorexia are not going up.

1898.55 -> So, this idea that the images that we're being bombarded

1901.24 -> with are causing anorexia doesn't seem to be true.

1905.19 -> Now, that is not to say that the images

1907.17 -> that we in particular young people are being bombarded

1910.569 -> with are healthy for the psychological state of mind.

1912.97 -> But classically define anorexia has existed at essentially

1917.28 -> the same prevalence for the last 100, 200,

1922.17 -> 300 and 400 years,

1923.68 -> which is incredible and really speaks to the likelihood

1926.6 -> that there's a strong biological contribution

1929.46 -> to what we call anorexia nervosa.

1932.12 -> Anorexia nervosa is extremely common.

1934.86 -> It's anywhere from one to 2% of women.

1939.79 -> And the typical onset is in adolescence close to puberty,

1944.06 -> but it can show up later in life as well.

1946.96 -> In fact, the identification and diagnosis of anorexia tends

1951.18 -> to be in the early '20s.

1953.47 -> But if you look back at the history of those individuals,

1956.56 -> there were typically signs of anorexia that back

1959.66 -> into their early teens.

1960.63 -> Or maybe even before that.

1963.715 -> Now, of course, men can be anorexic as well,

1965.44 -> but anorexia nervosa does seem to occur at 10 times the rate

1969.67 -> in women and young girls,

1971.61 -> than it does in men and young boys.

1975.1 -> So, while there does seem to be more

1977.21 -> of a prevalence of anorexia in boys and young men,

1981.22 -> these days, that's probably due to better diagnosis

1985.26 -> and detection than it is to some sort

1988.47 -> of societal shift related to imagery, et cetera.

1992.07 -> Later, we will talk about body dysmorphia

1994.18 -> and some of the images that are present in media

1997.54 -> and social media and how those are impacting other forms

2000.4 -> of eating disorders.

2001.233 -> But when you look at anorexia nervosa,

2003.47 -> this failure to maintain weight,

2005.35 -> even to healthy levels and often drops in weight

2008.32 -> that are very dangerous or even deadly,

2010.84 -> that has existed for a very long time,

2013.55 -> and seems to be somewhat hardwired into the biology

2017.27 -> of individuals that suffer from it.

2018.6 -> Now, when I say hard wired,

2019.64 -> that doesn't mean that it can't be treated or cured,

2022.13 -> and indeed it can.

2026.154 -> Bulimia which is defined as binge eating or overeating.

2028.64 -> Let me explain what that is.

2029.64 -> Binge eating is consuming vast amounts of calories

2032.16 -> in a short period of time.

2033.57 -> Overeating can be ingesting more calories than one needs,

2038.19 -> but over an extended period of time,

2040.36 -> both can exist of course, but bulimia is also very common.

2045.05 -> It's more common in young girls

2047.99 -> and in women that it is in young boys and in men,

2051.26 -> but it is present in both sexes.

2054.93 -> Bulimia and rates of bulimia might be increasing.

2058.95 -> That's sort of an interesting finding.

2061.42 -> It's not quite clear whether or not it's existed

2064.32 -> in its same form for a long period of time

2066.28 -> or within other new forms that are evolving or showing up,

2070.79 -> we're going to drill into bulimia

2072.437 -> and what it actually is and what it represents.

2074.518 -> But one thing I want to be clear about,

2077.67 -> just as the perfectionist mindset has been associated

2081.29 -> with anorexia, and it turns out that's not the case.

2085.44 -> It can be, but it's not always associated with anorexia.

2090.24 -> There was the idea that bulimia is associated

2092.96 -> with early trauma in childhood, in particular sexual trauma.

2096.55 -> And while that can be the case,

2098.72 -> there's no direct correlation between the two.

2101.69 -> Now, obviously psychological phenomena and trauma

2105.2 -> can have a profound impact on the way

2107.07 -> that the brain wires up and the way

2109.17 -> that people approach food and other types of behaviors.

2112.48 -> But the sort of classic idea was that all anorexics

2116.27 -> are perfectionists, they want to perform well.

2118.78 -> It's all about control and autonomy.

2120.9 -> And bulimics are kind of dysregulated and acting

2123.5 -> out against some early sexual trauma,

2124.562 -> those stereotypes of the psychological framework

2129.9 -> of anorexics and bulimics, doesn't hold up.

2133.22 -> When you look at the data, many,

2134.7 -> many meta analysis have been done.

2136.99 -> It just simply is not the case.

2138.78 -> And in both instances, both anorexia and bulimia,

2142.2 -> there are clear biological underpinnings,

2144.72 -> to what's driving the under-eating or the overeating.

2148.3 -> So, we're going to talk about the biology of under eating

2151.31 -> and overeating and appropriate levels of eating.

2154.73 -> And by doing that,

2155.77 -> we will start to identify some of the mechanisms

2158.28 -> that serve as entry points for the treatment

2161.63 -> of both anorexia and bulimia.

2165.287 -> And as some of you are probably aware,

2167.2 -> anorexia and bulimia can be comorbid,

2169.64 -> they can exist with one another.

2172.14 -> There are anorexics who will binge and then purge

2176.18 -> in order to maintain that unhealthily low weight.

2180.55 -> There are bulimics

2181.63 -> who fit the psychological criteria of anorexia.

2184.601 -> And so there's a lot of overlap

2186.82 -> between those two categories.

2188.48 -> Now let's talk about the categorization for a second and why

2191.43 -> the categorization has led to now a bunch

2194.06 -> of other eating disorders as defined

2196.17 -> by the psychiatric community.

2198.27 -> One of the classic symptoms of anorexia

2200.91 -> is a loss of menstrual cycles, loss of periods.

2204.4 -> And the reason for that is when the body is undernourished,

2207.62 -> the body fat stores, send signals to the brain

2212.02 -> to inform that the body is undernourished,

2214.44 -> or they turn off the signals that say, look,

2217.47 -> there are enough body fat cells out here

2218.88 -> to support healthy metabolism.

2221.16 -> And therefore let's shut down ovulation,

2224.073 -> literally signal sent from the fat and muscle

2227.26 -> to the brain and the brain,

2229.07 -> the hypothalamus and pituitary will send signals down

2232.37 -> to the ovaries,

2233.239 -> or they will turn off the signals heading to the ovaries

2236.66 -> to deploy eggs,

2238.93 -> to maturation of eggs in the follicle, et cetera.

2241.76 -> So, there are instances in which people have anorexia

2246.77 -> or have bulimia,

2247.77 -> but are still maintaining healthy menstrual cycles

2250.64 -> or at least menstrual cycles.

2251.99 -> And that has led to a whole set of other categorizations

2256.9 -> of eating disorders, like binge eating disorder,

2258.9 -> where there tends to be a lot of overeating,

2261.07 -> but not the purging or categorizations of anorexia,

2265.074 -> in which people are under feeding,

2267.1 -> but they are not losing their periods.

2269.01 -> And so these have a number of different names and acronyms.

2271.81 -> Some of them include things like, EDNOS,

2274.48 -> EDNOS is eating disorder, not otherwise specified.

2278.99 -> So, that's a sub categorization or OSFEDs.

2282.413 -> So, OSFEDs is or specified feeding or eating disorder.

2286.45 -> So, right now,

2287.58 -> if you were to look online or you're looking

2289.28 -> to the psychiatric and psychological textbooks,

2292.24 -> what you would find is that there's a huge constellation

2294.26 -> of eating disorders today.

2295.21 -> We're mainly going to talk about anorexia,

2297.63 -> bulimia, binge eating disorder and body dysmorphia.

2301.42 -> You can even find eating disorders like pica,

2304 -> where people actually ingest things like dirt or rocks

2308.1 -> or metal because they have a genuine appetite

2310.81 -> for those things.

2311.643 -> I certainly do not recommend sampling any

2314.63 -> of those non food items.

2316.12 -> As foods, is incredibly dangerous.

2318.62 -> People often poisoned themselves.

2320.52 -> They often can cause structural blockages

2324.09 -> some people have died from those sorts of things.

2326.64 -> But nonetheless, there are aspects of our brain

2330.01 -> and biology that when disrupted can lead

2331.97 -> to very bizarre types of eating behavior,

2334.7 -> sometimes pica is caused by malnutrition, but not always.

2338.19 -> And so today we're going to focus

2339.92 -> on the most prevalent eating disorders,

2342.02 -> but we are going to build up toward that understanding

2344.52 -> by looking at what healthy metabolism and eating

2348.6 -> and satiety and hunger looks like.

2351.01 -> Because one, I realized that not everyone

2353.13 -> out there has an eating disorder.

2354.7 -> And two, I want people to understand this relationship

2358.045 -> between how they think, the decisions they take

2361.97 -> about what they eat

2363.09 -> and how the body and the brain at subconscious levels

2366.65 -> are driving some of these behaviors healthy or otherwise.

2370.35 -> Because I do think that it can lead us to a better

2372.76 -> understanding of what healthy eating is for most of us,

2376.08 -> and to increase compassion and hopefully

2379.04 -> even increased improvement in treatment of eating disorders

2383.08 -> for those that are suffering from them.

2385.15 -> So, what is hunger and what is satiety?

2387.23 -> Satiety, of course being sated

2389.13 -> or feeling like we've had enough food.

2393.47 -> I want to remind people of the basic mechanisms

2395.77 -> by which the brain and body communicate.

2397.68 -> This is vitally important, not just for this discussion,

2400.07 -> but for any discussion, about how we think, how we behave,

2404.17 -> how we feel, the body is communicating two types

2407.68 -> of information to the brain on a regular basis,

2410.72 -> but in particular around feeding, and those two types

2411.792 -> of information are mechanical information,

2414.708 -> and chemical information.

2418.84 -> What do I mean by mechanical information?

2420.4 -> Well, if you take a deep breath, oh,

2423.15 -> and you hold your breath,

2424.24 -> what you'll find is that you can hold your breath

2425.61 -> a lot longer than if you exhale all your air

2428.04 -> and you hold your breath with lungs empty.

2429.79 -> And the reason is not because when your lungs are full,

2432.91 -> you have enough oxygen

2434.4 -> and therefore you can hold your breath.

2435.81 -> It's because when your lungs are full,

2438.3 -> a particular class of neurons called baroreceptors,

2441.23 -> send information to the brain and say,

2444.24 -> there's pressure in the lungs.

2445.4 -> And that means that there's probably oxygen in here.

2447.7 -> And so the trigger to breathe is actually suppressed,

2451.49 -> when your lungs are empty.

2452.76 -> Even if you have plenty of oxygen in your system,

2455.23 -> those baroreceptors send a different signal to the brain,

2457.61 -> which is there's no oxygen in here and you should breathe.

2460.63 -> And so the impulse to breathe comes earlier.

2462.47 -> Likewise, when your stomach is full,

2465.36 -> it sends signals to your brain that are purely based

2467.75 -> on this mechanical fullness,

2469.74 -> has nothing to do with nutrients, that says I'm full.

2474.06 -> And therefore don't be as hungry.

2476.73 -> Don't motivate to find or ingest food.

2479.5 -> Whereas when our gut is empty,

2481.3 -> even if we have plenty of nutrients

2483.28 -> or plenty of body fat stores,

2485.3 -> we tend to focus on food a bit more.

2487.9 -> So, volume and mechanical influences have a profound effect

2491.68 -> on how we think.

2492.75 -> And what consider doing or not doing,

2495.65 -> likewise chemical effects.

2497.87 -> When we ingest food,

2499.22 -> our so-called blood sugar or blood glucose levels go up.

2501.325 -> That information is signaled to the brain

2504.5 -> via neuronal pathways and hormonal pathways.

2508.98 -> And in particular, there are neurons within our gut,

2511.45 -> that signal to areas of our brain stem that are involved

2513.96 -> in satiety in our sense of having enough

2516.18 -> that there's food in our system.

2518.44 -> So, that's chemical information.

2520.53 -> So, how our hunger and feeding and satiety regulated

2525.63 -> by way of mechanical and chemical signaling.

2528.79 -> You have, I have,

2529.82 -> we all have neurons in our hypothalamus that trigger eating

2534.31 -> and neurons that trigger cessation or stopping of eating.

2538.8 -> We have an accelerator on eating and we have a break.

2540.423 -> And I covered all of this in a lot of detail in the episode

2544.55 -> on feeding and metabolism and hunger.

2546.72 -> So, if you want a lot more detail, see that episode,

2549.8 -> but right now,

2550.633 -> I'm just going to give you the top contour

2552.11 -> of how all that works.

2554.09 -> Your hypothalamus is an area of your forebrain,

2556.14 -> which tells you it's in the front,

2557.97 -> but it's at the base of your forebrain sits more or less

2560.18 -> above the roof of your mouth.

2561.44 -> The hypothalamus contains lots of different kinds

2563.55 -> of neurons, including neurons that stimulate sexual activity

2566.97 -> and desire, regulate your body temperature

2569.495 -> and control appetite and ceasing of eating and appetite.

2576.67 -> There are two types of neurons within a particular area

2579.26 -> of your hypothalamus that are relevant here.

2581.23 -> There are the so-called POMC neurons, okay?

2585.76 -> Pro-opiomelanocortin neurons that tend to act as more

2590.83 -> of a break on appetite,

2593.62 -> by way of another hormone

2595.08 -> called melanocytes stimulating hormone.

2596.83 -> And not so incidentally when you're getting

2599.23 -> a lot of sunlight and you're viewing a lot of sunlight,

2601.3 -> that system is ramped up.

2603.21 -> This is why appetite is lower in the summer months

2605.703 -> than it is in the winter months.

2607.48 -> This is true in animals.

2609.211 -> And this is true in humans.

2610.88 -> And you have a class of neurons called the AgRP neurons.

2614.06 -> The AgRP neurons are the ones that stimulate feeding,

2617.73 -> and they create a sort of anxiety or excitement about food,

2621.68 -> can be positive anxiety, or it can be negative anxiety.

2625.53 -> What do I mean by that?

2626.49 -> Well, if you ever seen kids heading in to get ice cream,

2629.91 -> they're absolutely excited.

2631.23 -> You see people getting raised, sit down and eat a big meal.

2634.44 -> They're excited to eat.

2635.53 -> Sometimes that's due to social factors,

2637.34 -> but they have an increase in overall levels

2639.66 -> of autonomic arousal.

2640.569 -> And depending on the context,

2642.68 -> they can feel excited or anxious,

2644.31 -> but it is a ramping up of energy.

2646.37 -> These AgRP neurons are what caused that,

2649.53 -> in fact so much so that if you eliminate

2651.556 -> or kill these neurons, which has been done

2654.74 -> in experimental mouse models in the laboratory,

2656.86 -> but also there are humans that have lesions

2658.81 -> or neurotoxic effects on these AgRP neurons.

2662.05 -> And what you find is that they don't want to eat.

2665.008 -> They essentially become anorexic,

2666.5 -> meaning they don't want to ingest food.

2669.083 -> They have no appetite for food whatsoever.

2671.27 -> Now that's not exactly what anorexia is,

2673.44 -> but these AgRP neurons are like an accelerator

2675.88 -> on wanting to eat.

2676.95 -> Whereas if you stimulate these AgRP neurons

2679.64 -> or in humans that have say a small tumor near

2682.58 -> these AgRP neurons, they become hyperphagic.

2684.95 -> They will eat to the point of bursting,

2687.09 -> both animals and humans that have elevated levels

2689.82 -> of these AgRP neurons are anxious.

2692.7 -> They want to eat,

2693.7 -> and they will ingest food to the point where they override

2696.68 -> those mechanical and chemical signals in the body.

2698.8 -> And I know it sounds horrible, and it is horrible.

2701.21 -> They will eat until the point that they burst.

2704.14 -> Now, there are signals coming back from the body

2707.32 -> to inform the brain about presence

2709.21 -> of different levels of nutrients.

2711.13 -> And that generally comes from three sources.

2713.47 -> First of all, is body fat.

2716.76 -> The more body fat we have,

2718.08 -> the more we secrete a hormone called leptin, L-E-P-T-I-N,

2721.79 -> leptin from body fat,

2723.35 -> leptin goes to the brain and suppresses appetite.

2726.741 -> This is a body to brain signaling mechanism that says, look,

2730.78 -> I've had enough,

2732.63 -> not incidentally, leptin signaling is disrupted

2736.53 -> in people that have bulimia and obesity

2739.72 -> and certain forms of binge eating disorder.

2742.49 -> So, that system has disrupted they have had enough signal

2746.05 -> or there's enough body fat here such that you don't need

2748.69 -> to eat more right here, I'm sort of in the voice

2751.3 -> of the body fat, trying to talk to the brain, that signal,

2755.483 -> that dialogue is mixed up or messed up.

2756.316 -> In some cases it's absent entirely.

2758.38 -> So, the body fat is signaling to the brain

2760.82 -> about how much reserve you have.

2762.82 -> It's sort of like a savings account for energy,

2764.807 -> 'cause that's what body fat is.

2766.56 -> You've got lipids in there and through lipolysis,

2768.193 -> that can be metabolized.

2769.5 -> If you're interested in that process,

2771.404 -> both how to increase it.

2773.41 -> And just generally how it works.

2775.29 -> You can see the episode on the science of fat loss.

2777.685 -> The body fat is doing something else really interesting

2780.5 -> that relates to anorexia,

2782.89 -> when they're sufficient levels of body fat

2784.83 -> and leptin circulating in the blood.

2787.27 -> And that leptin signal gets to the brain,

2789.97 -> the hypothalamus and the pituitary gland

2792.52 -> register that signal.

2794.5 -> And in a completely subconscious way,

2797.46 -> trigger the deployment of eggs in females and the production

2803.15 -> of sperm in males.

2804.95 -> So, when body fat stores are very low,

2807.18 -> the reason why periods shut off or sperm production

2810.22 -> is reduced or even shut off is because there's not enough

2813.52 -> leptin getting to the hypothalamus and to the pituitary.

2817.7 -> And they shut off the signals, the hormones,

2820.5 -> things like gonadotropin-releasing hormone,

2822.16 -> luteinizing hormone, follicle-stimulating hormone,

2824.4 -> all these hormones.

2825.233 -> So, you don't have to remember the names

2826.12 -> of if you don't want to that travel to the ovary

2829.26 -> or to the testes and cause the ovary and testes

2831.86 -> to ovulate or to produce more sperm.

2835.6 -> So, the reason why anorexic stopped having periods,

2839.33 -> while they stopped cycling,

2840.66 -> is because there isn't sufficient leptin in the bloodstream.

2844.06 -> Now there have been attempts to give leptin to anorexics

2848.54 -> because leptin has been sequenced and the peptide

2851.55 -> has been synthesized.

2852.67 -> And so you can inject leptin into people.

2855.262 -> There are studies where they've done that,

2857.52 -> when that happens, it does not tend to alleviate

2862.13 -> the anorexia, does not cause

2863.404 -> people to start eating again.

2864.84 -> And that actually makes sense because leptin is also a way

2867.92 -> of shutting off the hunger signals saying,

2870.35 -> it's the body fats way of saying, hey,

2871.89 -> there's a lot of body fat here,

2872.9 -> or there is sufficient body fat.

2874.16 -> There doesn't even have to be a lot, but it has,

2876.99 -> in some cases been shown to rescue the menstrual,

2879.99 -> cycling in some anorexics, okay?

2882.47 -> So, body fat is signaling to the brain.

2884.81 -> The gut is signaling to the brain.

2886.34 -> There are neurons in your gut that are primarily responding

2890.63 -> to meaning they fire electrical signals.

2892.41 -> When there are sufficient fatty acids coming

2894.71 -> from fats you ingest, amino acids coming

2897.66 -> from proteins you ingest and sugars coming

2900.37 -> from carbohydrates and sugars.

2901.94 -> Things like fructose, glucose, et cetera.

2905.08 -> Those signals are being sent from the fat and from the gut

2908.27 -> up to the brain.

2910.01 -> And therefore your body has multiple signals

2914.38 -> of directing you toward eating more or eating less.

2918.53 -> So, you've got two categories of neurons.

2920.13 -> One that acts as an accelerator, the AgRP neuron saying,

2923.07 -> eat, eat, and get you excited to eat.

2926.78 -> And then you have a category of neurons.

2928.54 -> The POMC neurons that are suppressing hunger.

2931.89 -> They're acting like a break, and the body is informing

2935 -> the brain all the time about the status

2936.67 -> of the body and whether or not it needs more food or not.

2939.83 -> So, you might ask why is it that people who are overweight

2942.44 -> and have a lot of body fat,

2943.99 -> why they would continue to eat a lot,

2945.74 -> well past a certain threshold of body fat that's

2948.26 -> when you start getting

2949.657 -> into these so-called metabolic disorders,

2950.92 -> where blood glucose metabolism is disrupted,

2953.01 -> leptin signaling is disrupted and there are all sorts

2956.05 -> of changes on both the brain side and the body end

2959.76 -> of things, such that they're hungry,

2962.24 -> despite the fact that the body has plenty

2964.34 -> of energy on reserve.

2966.26 -> Okay, that I think is sufficient to explain the basics

2970.88 -> of hunger and satiety are kind of a biological mechanism.

2973.99 -> And the important thing again,

2974.91 -> to remember is that they're mechanical and chemical signals

2977.71 -> that come from fullness or absence of fullness

2980.05 -> that come in the presence of glucose in the blood

2981.93 -> or the absence of glucose in the blood.

2983.96 -> When you haven't eaten for a long time,

2985.4 -> glucagon levels go up, for instance,

2987.59 -> GLP1 levels go up and those will drive you

2990.54 -> to seek out food and want food.

2993.041 -> And then there are the signals that are coming from body fat

2994.67 -> and from neurons in the gut.

2996.04 -> So, there's a lot of convergence, in a lot of pathways.

2998.8 -> I don't offer you all those pathways to confuse you.

3001.12 -> I offer you those pathways to clarify the extent

3005.38 -> to which something as simple as eating or the decision

3009.23 -> to not eat is complicated.

3011.58 -> We've perhaps heard,

3013.02 -> or I've certainly heard that, oh, you know,

3015.65 -> it takes about 20 minutes for satiety to set in,

3018.49 -> so you should eat slowly that you won't realize that you're

3019.995 -> full until about 20 minutes.

3022.52 -> That's actually not true.

3023.84 -> I don't know where that got started,

3024.96 -> but we should probably all chew our food better

3026.91 -> and eat more slowly,

3028.28 -> be more mindful of what we're eating, et cetera.

3030.82 -> So, in anticipation of this episode,

3034.24 -> I consulted extensively with a colleague

3036.31 -> of mine at Stanford,

3037.143 -> who sadly for us is going off to University of Pennsylvania.

3040.64 -> So, our losses University of Pennsylvania's win.

3044.23 -> His name is Dr. Casey Halpern.

3046.13 -> He's a MD, Medical Doctor and Neurosurgeon,

3049.84 -> and a PhD who studies binge-eating disorder

3052.3 -> and other types of eating disorders and how they arise

3054.98 -> in the brain.

3055.84 -> And he's developed some

3057.106 -> really pioneering treatments for them.

3060.11 -> We'll talk more about his work a little bit later

3061.86 -> in the episode, but we got to the discussion

3064.47 -> of why a body that has sufficient energy levels

3070.05 -> would desire to eat more at all.

3072.517 -> And this is not just the case for binge eating disorder

3075.47 -> for bulimia, but why that would be the case.

3077.78 -> You know, this is primitive biology

3079.56 -> that evolved over many tens.

3081.23 -> If not hundreds of thousands of years, you see it in mice,

3083.27 -> you see it in humans,

3084.35 -> very similar types of pathways and effects.

3087.38 -> How is it that human beings who have plenty

3090.69 -> of fat on reserve and plenty of glycogen

3093.16 -> in their liver, et cetera.

3094.76 -> In other words, plenty of energy, why they would be hungry,

3097.76 -> why they would eat at all.

3099.28 -> It seems like that just shouldn't happen.

3101.96 -> And he had a very important,

3104.45 -> and I think clear and intuitive way

3107.55 -> of framing up all this stuff around eating

3110.4 -> and motivated behaviors and how they can go awry,

3113.26 -> not just in eating disorders, but in all of us.

3116.91 -> Basically what he said was, from an evolutionary standpoint,

3122.6 -> it makes sense that we should eat as often as we can,

3126.68 -> as much as we can, and as fast as we can.

3130.63 -> Well, that sounds crazy.

3131.55 -> I've was told to eat not too often, not too much,

3136.37 -> and to eat slowly and chew my food.

3138.82 -> But as Dr. Halpern pointed out,

3142.01 -> there are circuits in the brain to reward eating

3144.23 -> often eating fast and cramming as much food

3148.17 -> into you as possible.

3149.4 -> Because from a purely evolutionary standpoint,

3153.39 -> food was scarce, and seeking food was dangerous,

3156.49 -> whether or not it was from animal sources or not.

3158.99 -> And it's always been competitive, for those of you that grew

3162.6 -> up in families with a lot of siblings.

3164.13 -> This may resonate with you.

3165.49 -> I just one sibling,

3168.213 -> we were competitive about certain things,

3169.046 -> but typically not competitive about food,

3170.45 -> but I had friends that had a lot of siblings.

3172.79 -> It was really interesting to see how food was served up

3175.62 -> and how it was taken in those households.

3180 -> It was like food would hit the table and it was just

3182.5 -> an absolute war for portions and who got what

3186.75 -> and how much and who got a slightly bigger piece

3189.01 -> of cake, et cetera,

3190.13 -> turned out to be a frequent happening in these meals

3194.04 -> and that these birthday parties,

3196.529 -> whereas the only children perhaps were used

3199.291 -> to having more food presented to them without having

3200.86 -> to compete with other members of the species.

3202.456 -> Every animal, including humans has a hardwired circuit

3207.43 -> that we were born with that pays attention

3210.12 -> to how much food is available, how much we are getting now

3213.53 -> and how much we are likely to get in the future.

3216.32 -> And without going down the rabbit hole

3218.52 -> of arcuate nucleus biology, in two sentences,

3223.88 -> you have a hypothalamic area called the arcuate nucleus.

3227 -> It's a fascinating area.

3228.26 -> It's actually the area that houses,

3230.02 -> these PMOC neurons and these other types of neurons

3232.48 -> that regulate hunger and satiety.

3234.673 -> And these neurons

3237.12 -> in the arcuate nucleus start getting active.

3239.7 -> When we see food and think about food,

3242.27 -> they drive hunger, and they drive hunger

3245.95 -> in a way that's responsive to what the food looks like,

3249 -> what it smells like,

3250.5 -> but also our prior history of interactions with that food.

3254.15 -> And it takes into account social context,

3257.34 -> whether or not we are going to get the whole pizza

3260.1 -> to ourselves or whether or not there are going to be others

3263.25 -> that we are going to have to compete with.

3264.76 -> So, there are a lot of signals that this arcuate nucleus

3265.876 -> in your brain are paying attention to.

3269.62 -> So, Dr. Halpern pointed out that you actually

3272.11 -> have an accelerator that increases your level of awareness

3276.19 -> and anxiety and sort

3277.57 -> of constricts your field of view and all your senses.

3280.58 -> Anytime you interact with food and is driving

3283.07 -> a primitive reflex to ingest as much food as you can,

3286.22 -> as quickly as you can,

3288.15 -> and then move on from there,

3289.71 -> and presumably to do the same elsewhere.

3292.16 -> So, that changed the way that I think about eating behavior

3296.387 -> and eating disorders.

3298.2 -> In fact, we could think about eating disorders like bulimia

3301.57 -> as an unmasking of that mechanism

3303.8 -> without the so-called top-down control,

3305.57 -> without the mechanisms that we use to regulate our behavior.

3309.35 -> And indeed bulimia and binge-eating disorder

3312.45 -> are closely associated with impulsivity

3315.78 -> and with impulsive behaviors of other kinds,

3318.83 -> something that we also will discuss more.

3321.82 -> What's the pathway?

3322.71 -> How does this work?

3323.543 -> What is Dr. Halpern and his colleagues doing in order

3326.63 -> to try and treat things like binge eating disorder?

3328.94 -> Well, you can frame all of behavior,

3334.06 -> good decision making and bad decision-making.

3336.95 -> In a pretty simple box diagram model.

3339.82 -> And I realized that many of you are listening to this,

3341.75 -> not watching this.

3342.76 -> There is no diagram to look at.

3344.14 -> I'll just explain it so that you can conceptualize

3346.65 -> it in your mind.

3348.63 -> We have knowledge of what we should do, in one box, okay?

3352.61 -> We should eat that.

3353.52 -> We shouldn't eat that.

3354.49 -> We should wait for dinner.

3355.39 -> We shouldn't wait for dinner.

3357.54 -> And then we have what we actually do in another box, okay?

3362.05 -> Now this is true for all behaviors,

3363.58 -> we should say something or we want to say something,

3366.12 -> but we don't, we shouldn't say something, but we do anyway.

3367.73 -> That's the knowledge that kind of looping in your head.

3372.765 -> I should do my homework.

3373.598 -> I should go for a run.

3374.45 -> I shouldn't do this right now.

3375.88 -> I shouldn't be on social media,

3377.54 -> all those kinds of shoulds and shouldn'ts

3379.32 -> that are circulating your head.

3380.69 -> That's one box.

3381.523 -> Then there's what you actually do.

3383.17 -> The behavior, whether or not you suppress the behavior,

3385.58 -> you turn off your phone and you go read a book or you go

3388.1 -> to sleep or whether or not you stay up all night,

3390.53 -> or you stay up for another hour, even five minutes.

3393.53 -> In between those two boxes are two intervening forces.

3397.12 -> And those intervening forces are critically important.

3399.97 -> Those intervening forces are homeostatic processes,

3404.21 -> called by some processes, same thing,

3406.79 -> homeostatic processes, that regulate the balance

3411.74 -> of different systems in your body, hot and cold,

3414.23 -> awake or asleep, dopamine and the desire to pursue things,

3418.79 -> serotonin and the desire to just relax and chill.

3422.29 -> So, homeostatic processes and reward systems.

3426.82 -> And as we now move into discussion about anorexia,

3429.367 -> and bulimia specifically,

3431.66 -> what you'll see is that anorexia and bulimia

3435.348 -> are not a breaking of the mindset of what one should do

3440.22 -> or shouldn't do.

3441.96 -> It's a disruption of these homeostatic and reward processes,

3446.31 -> such that decision-making is completely disrupted.

3448.867 -> And in many cases is not available

3451.23 -> to the anorexic or bulimic.

3453.11 -> Now, I don't want to be abstract here.

3455.261 -> What I'm saying is that the person who starves themselves

3458.82 -> to the point where they might die and in some cases,

3461.08 -> sadly do die.

3462.283 -> They can know perfectly well that their behavior is leading

3467.21 -> to bad outcomes and possibly even death.

3471.506 -> And yet they are not able to intervene unless

3473.99 -> they get particular clinical help,

3476.8 -> because the homeostatic processes, the signals from the body

3480.96 -> and brain that say, you need food.

3483.54 -> Those aren't registering in the same way

3485.92 -> that they are for other individuals.

3488.15 -> and for the bulimic or the person that suffers

3490.44 -> from binge eating disorder.

3491.528 -> They don't necessarily want to eat that food.

3494.93 -> They simply cannot help it.

3497.38 -> It's like a reflex for them,

3498.91 -> because the homeostatic processes

3502.09 -> and the reward processes associated with food,

3504.74 -> are such that they can't intervene

3506.89 -> between the should do X, Y, or Z,

3510.05 -> or shouldn't do X, Y, or Z.

3511.34 -> And what their actual behavior is.

3513.1 -> Now, this isn't just a biological mechanistic explanation

3517.19 -> for what could have been summarized in two sentences.

3519.66 -> What this is,

3520.82 -> is a roadmap of where interventions

3523.75 -> can really make a difference.

3525.42 -> So, as we talk about different drug based interventions

3528.39 -> or behavioral interventions or social interventions,

3532.7 -> I'd like you to think

3533.87 -> about whether or not those interventions are breaking into,

3538.36 -> or tapping into this box of the thinking,

3540.219 -> the sort of pattern of thinking around food,

3543.66 -> whether or not it's the behavior,

3544.69 -> the actual ingestion or the restriction of food,

3547.33 -> or whether or not it's tapping into the homeostatic process,

3549.98 -> the balance of energy systems and kind of getting enough,

3552.78 -> but not too much, or it's tapping into the reward system.

3556.96 -> And just as a little teaser of where we're headed,

3560.09 -> what you'll find based on the data clinical data experiments

3564.01 -> done very carefully and very well by excellent groups.

3567.06 -> What you'll find is the anorexics have a sort

3570.24 -> of switch that's been flipped,

3572.78 -> such that their decision-making

3574.44 -> is actually pretty darn good.

3576.16 -> It might even be better than yours in terms

3578.15 -> of evaluating food, nutritional content,

3581.01 -> but their habits are disrupted.

3583.24 -> So, they're not even consciously aware of the fact

3585.69 -> that they're making terrible.

3587.01 -> And in some cases, very dangerous food choices,

3589.43 -> and turns out that habits.

3592.83 -> And the way that we build and break and rebuild new habits

3596.8 -> is one of the most effective treatments for anorexia.

3599.56 -> So, now let's talk about anorexia,

3601.11 -> this failure to consume enough energy,

3602.315 -> such that the individuals at risk of death,

3606.25 -> and if not death, then severe metabolic disorders,

3610.03 -> lack of bone density, et cetera.

3612.64 -> As I mentioned earlier,

3613.64 -> anorexia and things that almost certainly were,

3617.83 -> and are anorexia have been described as early

3619.71 -> as the 1600s.

3620.88 -> And maybe even earlier,

3622.27 -> there are some records from the saints,

3624.32 -> from the 1400s of people that refuse to ingest food.

3629.25 -> Another common myth is that anorexia is only the sort

3634.3 -> of thing that you see in rich societies.

3637.43 -> These are spoiled children with so much food

3640.02 -> that they decide they're only going to focus

3641.65 -> on how slim they are,

3643.74 -> how they look in bathing suits, et cetera, not true.

3646.682 -> A careful analysis through medical epidemiology has shown

3651.08 -> that you find anorexia even in cultures

3653.62 -> and societies where food is scarce.

3656.3 -> So, that really speaks to biological mechanism.

3658.75 -> Now it's hard to unveil in societies where food is scarce,

3662.23 -> because a lot of people are starving and hungry,

3664.843 -> but there are individuals that choose still to avoid food

3669.88 -> and seem to have some sort of reward mechanism that rewards

3673.29 -> them, where makes them feel better if they don't eat,

3676.75 -> despite the fact that their body

3679.79 -> is severely depleted of nutrients.

3682.04 -> So, that's very interesting and points again

3683.84 -> to some disruption in some biological mechanism.

3686.59 -> Now, I want to make sure that I'm emphasizing

3689.65 -> that I'm not in favor of people,

3692.55 -> in particular young children, adolescents,

3695.01 -> and teenagers being bombarded

3696.37 -> with unrealistic imagery about bodies.

3699.07 -> But the idea that that's the cause of,

3701.76 -> or is amplifying anorexia, the data just don't seem

3705.21 -> to support that, anorexia in its classic sense,

3709.78 -> requires that there be an endocrine,

3712.65 -> meaning a hormonal disruption,

3714.93 -> menstrual abnormalities, lack of sperm production,

3717.53 -> or low testosterone in males, in order to meet

3720.76 -> the classification for anorexia.

3723.55 -> But as I mentioned earlier,

3724.6 -> there are now nuanced and new classifications of anorexia

3729.32 -> that even for individuals that still menstruate

3731.78 -> or that maintain a sperm production anorexia,

3735.34 -> can still be considered

3736.71 -> a clinically diagnosable disorder.

3739.27 -> Now, typically anorexia starts in adolescence,

3742.63 -> right around puberty.

3743.64 -> Let's take a look at what puberty is.

3745.44 -> Puberty at a very broad level is the most significant

3750.18 -> and dramatic developmental step.

3751.98 -> Anyone goes through in their lifespan.

3753.88 -> The body changes, the brain changes, perceptions,

3756.08 -> change, one's own self perception, changes.

3759.4 -> And most of those changes are driven by changes in circuitry

3763.63 -> within the hypothalamus.

3765.12 -> So, neurons that are controlling the production

3767.01 -> of the so-called sex steroid hormones,

3769.57 -> things like testosterone,

3770.54 -> estrogen, and related hormones, prolactin, et cetera.

3773.43 -> Those are all changing at very rapid rates.

3777.69 -> Anorexia tends to show up around this time in a subset

3780.7 -> of individuals who on the face of it seem to find food,

3785.04 -> aversive, now the purely psychological theory

3787.82 -> of this is that they are fighting for autonomy.

3790.55 -> They want control.

3791.85 -> Puberty is also a time in which children and parents

3794.57 -> are in a tug of war over control.

3797.24 -> You were once a small child being told when to go to bed

3800.49 -> sent to your room.

3801.43 -> Now you're a child that can talk back and say,

3803.86 -> I don't want to, or I refuse to.

3806.21 -> And that happens a lot in various households,

3809.25 -> as I'm sure you're familiar with.

3810.896 -> Adolescence and puberty

3813.3 -> is also when girls start menstruating typically,

3817.5 -> or boys develop deeper voice,

3821.89 -> they start producing sperm, et cetera.

3824.47 -> So, there are a lot of bodily changes

3825.8 -> that also drive perceptual changes and perceptual changes

3828.43 -> that drive bodily changes.

3829.97 -> And it is a dramatic shift for a young girl

3833.71 -> or boy that doesn't nourish themselves sufficiently.

3836.76 -> During that period,

3837.593 -> there are a number of downstream negative effects.

3840.41 -> I'll list out some of them,

3841.61 -> these are just a subset of the effects, hypogonadism.

3845.33 -> That's the lack of sperm production

3847.87 -> or healthy egg production.

3850.1 -> There is amenorrhea,

3852.39 -> which is the lack of menstrual cycling, okay?

3855.16 -> So, a failure to have a menstrual cycle.

3857.71 -> Reduced insulin secretion, insulin is this hormone

3860.13 -> that's released in order to help shuttle glucose

3863.36 -> into various tissues for energy utilization.

3865.66 -> That's down because energy levels are down so much.

3868.33 -> One of the symptoms that's a little more cryptic,

3870.39 -> and that has actually interesting implications

3872.49 -> for sake of the cholesterol hypothesis is that anorexics

3877.62 -> who ingest very little food often have cosmically

3881.45 -> high levels of cholesterol, including LDL,

3884.01 -> low density, lipoprotein cholesterol.

3886 -> You say, well, how could that possibly be?

3887.48 -> We were all told and continue to be told

3889.94 -> from many sources that ingestion of dietary cholesterol

3893.48 -> is what drives high levels of bodily cholesterol.

3895.94 -> Cholesterol is manufactured by the liver and in anorexics

3900.03 -> who consume very little food.

3902.058 -> They often have cosmically high levels of cholesterol,

3906.14 -> which is one of the kind of wrinkles

3908.57 -> in the so-called dietary cholesterol hypothesis

3911.58 -> that all of our cholesterol that we see on a blood panel

3914.61 -> is due to what we eat.

3915.979 -> But the explanation for it is that under conditions

3919.62 -> where there's not sufficient cholesterol

3921.26 -> to synthesize the sex steroid hormones,

3923.4 -> things like testosterone and estrogen,

3925.01 -> which are required in both males and females,

3927.13 -> those are made from cholesterol that the body,

3931.36 -> the liver will start generating its own cholesterol

3933.84 -> will often overshoot the mark to a dramatic degree.

3937.233 -> So, the blood lipid profiles and anorexics

3939.87 -> are often very unhealthy despite the fact

3942.21 -> that they're eating very little food.

3944.86 -> In addition, they tend to have elevated levels

3947.04 -> of things like vasopressin,

3948.6 -> which are hormones that regulate body temperature

3950.92 -> and salt and blood volume.

3954.16 -> They tend to have low blood pressure.

3955.42 -> They can pass out.

3956.4 -> I mentioned some of the other symptoms earlier.

3959.93 -> In other words, there are a huge number

3961.76 -> of terrible things happening.

3963.13 -> Thyroid levels are down.

3964.52 -> Heart rates are down, if I'm painting a very bleak

3967.5 -> picture here is indeed a bleak picture.

3970.25 -> So, we have to ask ourselves what can be done

3973.3 -> for the anorexic, right?

3975.592 -> Let's say it's a failure of the AgRP neurons

3979.31 -> to stimulate appetite and feeding.

3982 -> Let's say it's too much anxiety around food.

3984.23 -> Let's say it's because of the way that food restriction

3987.21 -> was used for reward in the household, right?

3989.37 -> I'm making this up,

3990.203 -> but you can imagine a hypothetical scenario

3991.84 -> where let's just say the mother of a particular individual

3996.85 -> is very vocal about her avoidance of food.

3999.11 -> We've seen this before, right?

4000.3 -> You've probably seen somebody who loves to cook

4002.33 -> and prepare food, but then sits down

4003.73 -> and doesn't seem to eat.

4005.352 -> And they always seem to in air quotes have eaten earlier.

4009.002 -> I ate while I cooked, I ate while I cooked, right?

4009.93 -> These people that you never actually see eating,

4012.85 -> we all know people like this, are they anorexic?

4014.7 -> Possibly, we don't know.

4017.05 -> A child observes that kind of behavior.

4018.96 -> Maybe that individual is being always being told how

4021.4 -> beautiful they look or how wonderful or fit they look,

4024.19 -> what incredible meals they produce.

4026.6 -> And you could imagine a purely psychosocial set of events

4032.46 -> that could lead a child to be anorexic.

4034.96 -> That doesn't seem to be the case,

4036.92 -> at least not in terms of driving classic,

4039.62 -> anorexia, a really extreme deprivation of oneself from food.

4045.23 -> However, there is a strong genetic component for anorexia.

4048.81 -> So, you could imagine a mild form of anorexia in a parent

4052.8 -> that is supported or exacerbated by praise,

4057.73 -> so that the person feels good from the praise

4059.83 -> they're getting, that they want to be a low body weight

4063.58 -> for whatever reason,

4064.48 -> for aesthetic reasons or for whatever reasons that happened

4067.35 -> to appeal to them.

4068.47 -> And the child has a genetic predisposition, right?

4072.44 -> We never think about genes in terms of controlling behavior,

4075.33 -> genes, bias, probabilities for behavior, okay?

4079.65 -> So, you can have a gene for depression of schizophrenia,

4081.78 -> but it's not deterministic, in the same way

4084.29 -> that there are genes that determine your eye color,

4086.83 -> or your skin color or your hair color, okay?

4090.32 -> So, there's a genetic predisposition there.

4093.06 -> And that genetic predisposition could exist such that if one

4096.98 -> is rewarded enough times for a particular behavior,

4100.38 -> that behavior can start to ratchet in

4104.06 -> to our neural circuitry,

4105.26 -> because behavior drives neural changes,

4107.13 -> so called neuroplasticity.

4108.42 -> And you could imagine that that child could develop

4111.34 -> a full-blown case of anorexia.

4113.23 -> And this is why I raised at the beginning that no one really

4116.25 -> knows how to define healthy eating.

4118.31 -> And so therefore we have to rely on just identification

4122.55 -> of unhealthy behaviors,

4123.92 -> but what do we point people to in terms

4125.5 -> of what healthy replacement behaviors would be.

4128.74 -> So, rather than just look at anorexics and say,

4131.41 -> they're not eating enough.

4132.46 -> And there's this huge array of terrible things

4134.71 -> that they're doing to their body, and they need to eat more.

4137.27 -> We need to rescue them from themselves.

4139.72 -> Let's look under the hood.

4140.96 -> Let's look at, what's known about the neural circuitry

4143.46 -> and the sorts of perceptions and behaviors

4145.79 -> of the neural circuitry is driving,

4147.79 -> in order to understand what they are truly suffering from,

4151.79 -> at the level of cause ,not just symptoms,

4154.2 -> it's clear what they're suffering from at the level

4155.91 -> of symptoms, symptoms are how we diagnose.

4158.479 -> I listed off a number of those things,

4161.76 -> but let's look under the hood and try and identify

4164.65 -> where one could intervene in theory,

4168.66 -> in order to try and rescue the anorexic

4171.3 -> or help the anorexic rescue themselves.

4174.45 -> Because it turns out that the answer or at least one

4178.18 -> of the answers of how to do that is not intuitive at all.

4181.21 -> At least to me was very surprising.

4183.51 -> I would be remiss if I didn't start with the obvious,

4186.12 -> which is, is there a chemical defect?

4190.02 -> Meaning is there some disruption in one of the major

4193.54 -> chemical systems in the brain that makes anorexics anorexic

4197.28 -> and therefore, can we replace that chemical?

4199.534 -> Or can we reduce some chemical

4201.35 -> and essentially eliminate anorexia?

4204.14 -> And the answer is not really sort of maybe no,

4208.79 -> here's why, there are a lot of different chemicals

4211.21 -> in the brain and body,

4213.27 -> but there are a category of chemicals that are particularly

4216.83 -> important that if you've listened to this podcast before,

4219.33 -> even if you haven't are going to come up again

4222.46 -> and again and again,

4223.45 -> and that is the category of chemicals in the brain

4225.56 -> and body called the neuromodulators,

4227.93 -> neuromodulators are different than neuro-transmitters

4230.55 -> in the sense that neuromodulators modulator

4233.449 -> or change the activity of brain areas in neural circuits,

4235.51 -> you can think of them as microphones that are held

4238.81 -> between particular sets of connections in the brain

4241.29 -> that make those connections in the brain,

4243.01 -> more likely to be active relative to others, okay?

4246.87 -> They make them louder so to speak,

4249.92 -> there are many neuromodulators,

4251.21 -> but the ones that are important for sake

4252.65 -> of today's discussion are the classic ones,

4255.39 -> dopamine, acetylcholine,

4256.69 -> or epinephrin and serotonin.

4259.02 -> Let's focus on serotonin.

4260.33 -> Serotonin is a neuromodulator that tends to increase

4266.3 -> the activity of certain neural circuits,

4268.59 -> including within the hypothalamus,

4270.19 -> but also within the body that trigger a sense of satiety,

4274.42 -> of having enough, enough food, enough warmth,

4279.01 -> enough social connection,

4281.09 -> enough of any motivated goal or drive or any type of thing

4287.12 -> or behavior that one would want more of,

4289.5 -> serotonin tends to make those circuits quiet down.

4294.79 -> Now, there are many categories of drugs that emphasize

4299.18 -> the serotonergic circuitry, meaning they cause the release

4302.05 -> of, or the efficiency of serotonin in the brain and body.

4305.35 -> Things like Prozac, Zoloft, Paxil, things of that variety.

4310.41 -> Those drugs have been used to some degree of success.

4314.26 -> Although not much to treat things like anorexia nervosa.

4318.48 -> That should make sense, because if these drugs increase

4321.82 -> serotonin, if their general effect is to increase serotonin,

4326.249 -> it will be to lower anxiety.

4328.76 -> That sounds like a great thing.

4330.26 -> A lot of anorexics are really anxious around food.

4333.32 -> We'll talk about why, lowering anxiety you might think

4336.61 -> would lead to ingestion of more food,

4338.67 -> but that's not often what happens, increasing serotonin,

4343.04 -> by way of some drug regimen will tend

4345.93 -> to make one less hungry, because with heightened levels

4350.66 -> of serotonin in the blood and brain,

4353.4 -> there isn't the desire to go seek out the things

4355.83 -> that will raise serotonin on their own.

4357.8 -> Now, some anorexics do well or benefit

4360.71 -> from these serotonergic drugs,

4363.48 -> these drugs that increase the activity of these circuits

4365.82 -> that leads to satiety.

4366.847 -> But if you think about the major goal of treating

4371.09 -> an anorexic it's to get them

4372.69 -> to have more hunger, more appetite.

4375.63 -> So, now I want to focus on some of the work that's been done

4379.516 -> around the habits and behaviors of anorexics,

4381.3 -> because those turned

4382.133 -> out to be ideal places for intervention.

4386.97 -> The work I'm about to describe was done

4389.54 -> by Dr. Joanna Steinglass and colleagues

4391.89 -> at Columbia University in New York.

4393.81 -> And there are other groups as well.

4395.24 -> Of course, they're doing this type of work,

4396.91 -> but they did what I think are really some beautiful

4401.379 -> experiments and some beautiful explorations

4403.21 -> of potential treatments for anorexics.

4405.04 -> That seemed to have a quite high degree

4408.469 -> of effectiveness when they are applied correctly.

4412.32 -> First of all, there's a challenge in studying anorexia

4415.26 -> because in anorexia,

4416.33 -> what you're essentially studying is the absence

4419.42 -> of a behavior.

4420.41 -> It's very hard to study the absence of a behavior,

4423.32 -> as opposed to a behavior.

4425.51 -> So, they did some experiments with anorexics,

4427.61 -> giving them a gallery of pictures of different foods,

4431.67 -> and allowing those anorexia patients

4434.12 -> to arrange those foods,

4435.4 -> according to preference about what they would select,

4439.04 -> about food, nutrient content about caloric content.

4443.13 -> They essentially asked these anorexics to evaluate food,

4447.14 -> and in doing so,

4447.973 -> they were able to identify something that's very unique

4450.87 -> to anorexics at the level of their perception of food.

4455.29 -> What they found is the anorexics,

4457.83 -> rather than being anxious in the presence of food,

4460.4 -> and that anxiety driving and avoidance of food.

4463.253 -> What they found is that anorexics have a hyper acuity,

4467.05 -> a hyper awareness of the fat content of foods,

4470.34 -> almost to the point of being sort of fat content savant.

4473.89 -> Now they don't necessarily know that they're doing this.

4476.84 -> They're not looking at an avocado and thinking, okay,

4478.91 -> that's X number of grams of fat rather,

4480.702 -> or looking at an apple and saying, okay, that has no fat.

4483.933 -> They start to do this more or less reflexively.

4487.12 -> Now it's a well-known symptom of anorexia,

4489.9 -> especially young anorexics that they have kind

4493.35 -> of an obsession with food, caloric contents,

4496.14 -> macronutrient ratios, meaning fat protein

4499.04 -> and carbohydrate ratios.

4500.94 -> They know caloric numbers,

4502.269 -> but then they sort of pass that information

4504.81 -> into a memory system in their brain that allows

4507.97 -> their interactions with food, to be very reflexive

4511.38 -> in a way that they are actively avoiding high-fat content,

4516.03 -> foods, calorie rich foods,

4517.82 -> and defaulting towards very low calorie foods.

4520.86 -> If they have to eat.

4523.03 -> Now, this might seem like an almost trivial result

4526.467 -> on the face of it, you think, okay,

4527.828 -> they don't like to eat when they do eat.

4529.671 -> They eat low calorie, low fat foods, duh,

4530.84 -> but it's the way in which they are doing this subconsciously

4535.01 -> that they learn this information and then they pass

4537.07 -> it off to a reflexive habit.

4539.2 -> And that's very important because what that means

4541.96 -> is that we need to look at what processes in the brain,

4544.93 -> what brain areas,

4545.77 -> what chemicals drive decision-making and knowledge.

4549.96 -> And we also need to look at the areas of the brain

4552.34 -> that drive habit formation and habit execution,

4557.4 -> because for any of you that have habits.

4559.447 -> And that means all of you,

4561.44 -> the hallmark feature of a habit is that it's reflexive.

4564.13 -> You have a mosquito bite on your leg, you scratch it.

4566.47 -> You didn't necessarily even think, oh,

4567.99 -> I'm going to scratch that.

4569.274 -> In fact, just to take a little bit of a moment of respites

4573.12 -> and talk about habits in general,

4575.8 -> there's a beautiful study that was done out

4577.62 -> of Caltech University,

4580 -> looking at the parking lot of where people park

4584.241 -> in the morning, without designated parking spots,

4585.81 -> and the trajectories that they use to walk to their offices

4588.77 -> in the morning.

4589.603 -> So, they put cameras up on the roof of Caltech,

4590.487 -> is the kind of thing that the nerdy kids at Caltech do.

4593.31 -> I think at Caltech,

4594.39 -> if you call someone a nerdy is I think it's a compliment.

4596.17 -> So, my apologies to the non nerds at Caltech,

4598.42 -> I think there's one or two of you and for the nerdy ones

4601.22 -> of you at Caltech, you're welcome.

4603.77 -> They videotaped the behaviors of these faculty

4606.1 -> and students and staff.

4608.839 -> And what they found, is that people follow trajectories

4611.04 -> from their car that are remarkably stereotype.

4613.73 -> First of all, they tend to park always in the same spot.

4616.77 -> If they can, they tend to get out of their car.

4619.01 -> Of course, 'cause they're on the driver's side

4620.24 -> or passenger side in the same place.

4622.07 -> They turn and pivot their body at approximately

4624.85 -> the same rate every day.

4625.683 -> They close the door,

4626.97 -> they've put their bag on their shoulder

4628.53 -> or across their chest,

4629.57 -> or however it is that they carry their briefcase

4632.118 -> or whatever it is.

4632.973 -> And they follow trajectories onto campus

4635.14 -> that are so stereotyped.

4636.77 -> That you'd wonder if you just trace line,

4638.61 -> after line after line.

4639.53 -> What you'd find is that every day is almost exactly the same

4643.73 -> and you do this too.

4644.95 -> You don't realize it because if you're being videotaped

4647.99 -> in this kind of behavior, it's not being released to you,

4650.13 -> but your behaviors are so stereotyped to the point

4653.2 -> where if you were to see them laid out in front of you,

4655.44 -> in kind of diagrammatic format of the lines

4658.1 -> and the trajectories that you follow throughout the day,

4660.41 -> the lifting of your mug and how frequently

4662.55 -> you drink each hour,

4663.63 -> you would be amazed and probably a little bit scared

4667.81 -> by how much of a robot we all are.

4670.553 -> Now that robotic aspect of our neurocircuitry is vital,

4674.72 -> because it's what allows us to think about other things

4677 -> and do other things, and drive other behaviors.

4679.83 -> But the work of Dr. Steinglass and colleagues showed

4683.08 -> that in the case of the anorexic,

4685.3 -> those habits are exactly the place where things start

4688.71 -> to go awry.

4690 -> And that drive this very dysfunctional under-eating behavior

4693.74 -> that sadly often leads to death

4696.15 -> or certainly bad medical outcomes.

4698.6 -> And it turns out that the brain areas associated

4701.66 -> with habit formation and execution

4704.28 -> are the best point of intervention.

4706.65 -> So, what Dr. Steinglass and colleagues did,

4708.92 -> is they took anorexics and they of course had control groups

4713.02 -> and they put them in an FMRI scanner,

4716.21 -> which are these brain scanners that allow you to evaluate

4719.07 -> which brain areas are active, during particular tasks.

4722.43 -> And because when you're in one of those scanners,

4724.28 -> you actually, you know,

4725.99 -> I've actually been in one of these things.

4727.22 -> You're biting down on a bite bar and you're most

4730.03 -> of the time and most all of these scanners you're immobile.

4732.56 -> So, you're looking at things on a TV screen.

4734.15 -> Sometimes you can press buttons to select choices

4737 -> and so forth, but you can't really eat within those things.

4739.929 -> What they found was that reward based decision-making,

4745.96 -> the drive to pursue a particular food or the drive

4750.04 -> to perform a particular task,

4752.48 -> which is a lot of what we do throughout our day,

4755.25 -> that was controlled by a brain area called

4756.79 -> the ventromedial prefrontal cortex.

4759.21 -> Let me simplify a little bit of this,

4760.83 -> but I'm going to simplify it by giving you a little detail,

4763.53 -> because it's the Huberman Lab Podcast.

4765.03 -> And I believe in mechanism,

4767.29 -> mechanism is the way that you get true understanding

4769.71 -> and that you can then be very quick and give overviews

4774.1 -> of things, but you need the mechanism.

4776.25 -> So, you have reflexes and you have neural processes

4783.9 -> that include what are called duration path

4785.94 -> and outcome type processes,

4787.77 -> a duration path, outcome type process,

4789.91 -> we can shorten with DPO.

4792.13 -> DPO is for all types of goal related behaviors.

4797.24 -> So, for instance,

4798.17 -> if you want to get a particular grade on an exam,

4800.75 -> you want to learn something, you want to complete a workout.

4802.59 -> You want to go to the grocery store and pick some stuff up

4805.28 -> and then head home.

4806.49 -> You're going to think duration.

4808.29 -> How long do I have, okay,

4809.43 -> do I have 45 minutes to get to the store?

4811.18 -> How long does it take to get to the store path?

4812.841 -> Which way am I going to drive there?

4814.5 -> Which way am I going to navigate through the grocery store,

4817.05 -> outcome, was able to get in and get the items I need

4819.47 -> and get home in time, okay?

4821.01 -> DPO, duration path outcome.

4822.65 -> It's a very conscious process.

4824.167 -> You tend to take into account different criteria related

4827.47 -> to what's preventing you from accomplishing

4830.56 -> what you want to do

4831.393 -> and what's helping you or assisting you.

4834.46 -> So, of course,

4835.293 -> as you get to the checkout line in the grocery store,

4836.54 -> you're going to select the shortest line for instance.

4838.18 -> So, that's all DPO stuff.

4839.41 -> It requires decision-making and it's reward-based,

4842.8 -> you use these DPO type processes in the short term

4846.57 -> to pick up groceries and pick a line at the grocery store

4850.25 -> and decide which trajectory to take home.

4852.867 -> And you use them for navigating long extended processes

4856.92 -> in life, trying to get a degree or raise children

4859.11 -> or get through a particularly challenging year, et cetera.

4863.7 -> So, duration path outcome,

4865.27 -> and that entire process relies on your fore brain.

4869.431 -> This prefrontal cortex,

4871.55 -> the prefrontal cortex is what allows you

4873.87 -> to take information from memory,

4875.53 -> combine it with information about what's happening

4878.27 -> in the present context, and then to direct your behavior,

4881.99 -> your speech, et cetera, toward particular outcomes.

4885.68 -> And if all that sounds like a mouthful, it is,

4889.28 -> and it's very metabolically demanding,

4891.01 -> decision-making is metabolically demanding.

4893.22 -> It takes effort, okay?

4896.8 -> Reflexes on the other hand,

4899.1 -> don't involve the prefrontal cortex in the same way,

4901.56 -> habits and reflexes.

4902.629 -> Like once you know how to walk, you get up and you walk,

4905.85 -> you don't have to think about right foot, left foot,

4908.392 -> right foot, left foot.

4909.225 -> You just do it.

4910.058 -> That doesn't rely on prefrontal cortex.

4911.85 -> It's subconscious as it's sometimes called,

4913.88 -> but basically you don't have to use the parts of the brain

4916.89 -> that are involved in duration path

4918.44 -> and outcome type analysis.

4920.41 -> Okay, so, in this particular study,

4923.36 -> they examined brain activity in anorexics

4926.94 -> who are selecting different foods.

4929.94 -> And as I mentioned earlier,

4930.94 -> they have a hyper acuity or awareness of which foods contain

4935.51 -> more or less calories than other foods

4937.46 -> and what the fat content of particular foods is,

4940.1 -> in particular, et cetera,

4942.42 -> they're doing all this while in a scanner.

4945.31 -> And then they look at what sorts of brain areas

4948.34 -> are active after that task is done.

4951.72 -> And what they found was really interesting,

4953.67 -> what they found was that the dorsal lateral prefrontal

4956.36 -> cortex not surprisingly is involved in the decision-making

4961.55 -> and the evaluation of this food,

4964.14 -> which foods are going to be best to eat in this context,

4967.85 -> which foods are going to be appropriate for at least

4971.29 -> that anorexics framework about what's okay to eat

4974.42 -> and what's not okay to eat and how much.

4976.349 -> However, there are areas of the brain that were active after

4981.83 -> that decision-making process.

4983.69 -> And those are the brain areas that turn out to drive

4986.73 -> the habit of avoiding particular foods

4989.41 -> and approaching other foods.

4991.48 -> And in that case,

4992.313 -> it wasn't the dorsolateral prefrontal cortex.

4994.284 -> It was an area of the brain called

4995.93 -> the dorsal lateral striatum.

4997.676 -> Now the striatum is a big area in the brain.

5000.97 -> It's involved in a lot of different things.

5003.09 -> It includes areas like the caudate and putamen.

5005.113 -> And I just want to mention, as I throw out all these names,

5007.81 -> you do not need to remember the names

5009.84 -> of these different structures.

5010.85 -> They're just there,

5011.683 -> if you are interested in that level of detail,

5013.96 -> but basically you have a brain area and anorexics

5016.17 -> have a brain area that's involved in evaluating

5018.23 -> and decision-making around food.

5019.77 -> And then another brain area that's involved

5022.17 -> in the reflexive consumption of particular foods

5025.95 -> and the reflexive avoidance of other foods.

5030.52 -> If you remember way back at the beginning of the episode,

5034.346 -> I feel like that was a long time ago now.

5035.31 -> When we talked about how you have these sorts of processes

5038.58 -> in the brain,

5039.413 -> but there are always homeostatic

5041.61 -> and reward systems influencing this kind of thing.

5045.38 -> Well, in the brain of the anorexic,

5048.91 -> it turns out that the reward systems have been attached

5052.76 -> to the execution of habits in a way that is unhealthy

5057.04 -> for body weight,

5058.28 -> but at least from a purely neural circuit perspective,

5061.65 -> the reward is now given this chemical reward in the brain,

5065.58 -> is given for avoiding particular foods and only approaching

5069.57 -> these very low calorie, low fat foods.

5073.43 -> So, there really does seem to be a flip in the switch,

5077.32 -> in the anorexic brain that rewards them internally.

5080.5 -> They feel good when they avoid certain foods

5083.94 -> and they approach others.

5085.37 -> So, it's not a deprivation based model

5087.84 -> where they are flagellating themselves or masochistic

5091.364 -> or actively avoiding food in order to punish themselves,

5095.56 -> which is interesting because a lot of psychological theories

5097.69 -> support that idea.

5099.12 -> Rather, once this transitions into a set of habits,

5104.28 -> they are actually getting a sense of reward.

5106.46 -> They feel good, presumably from the release

5108.54 -> of a different neuromodulator called dopamine,

5112.26 -> by approaching foods that are low fat, low calorie content.

5116.4 -> And so their whole brain circuitry

5118.07 -> is skewed toward avoiding particular things.

5121.07 -> And they actually are rewarded for that, and they feel good.

5124.64 -> They feel better than if they were eating

5126.79 -> in a healthy weight supporting way.

5130.8 -> Now the dorsolateral striatum is a structure

5133.44 -> that we should think about in a little bit more depth.

5136.1 -> It's part of a set of circuits that are involved

5138.81 -> in what are called go no-go tasks.

5140.87 -> And I don't want to go into this in a lot

5142.13 -> of detail right now,

5144.15 -> because it would take us too far down

5145.29 -> the rabbit hole of neurocircuitry.

5147.448 -> But basically in terms of behaviors,

5151.91 -> we both have DPO type behaviors.

5155.39 -> So, decision-making, reward based behaviors.

5157.8 -> And we have habits that we learn and we acquire.

5162.25 -> And then we just start to reflexively, things like walking,

5165.48 -> things like yawning when we're tired,

5167.73 -> things like taking a particular route

5169.55 -> through the parking lot, right?

5171.16 -> We learned that the first time we go to a given parking lot

5173.66 -> and walk into a building.

5174.493 -> But after that, we tend to follow

5175.63 -> the exact same trajectory becomes very automatized.

5179.092 -> It's just like, we just do it without thinking.

5182.27 -> Well, the go no-go circuitry is another aspect

5187.98 -> of our behavior,

5188.813 -> where we both have to select behaviors to perform.

5191.315 -> And we have to select behaviors to suppress.

5194.83 -> And the anorexic brain seems to reward suppression

5199.98 -> of one set of behaviors,

5201.29 -> ingestion of high calorie foods, and to reward focus,

5206.42 -> or even hyper-focus and consumption of low fat,

5210.44 -> low calorie foods.

5212.03 -> So, this homeostatic process that we learn

5214.28 -> about from like high school onward,

5216.27 -> that, oh, everything in your body is designed

5218.19 -> to keep everything in balance.

5219.72 -> You stay awake for a certain amount of time.

5221.28 -> You want to sleep, you don't eat for a while.

5223.19 -> Then you want to eat to maintain weight, right?

5225.06 -> You eat too much.

5225.893 -> Then you want to eat less.

5227.15 -> Those systems are disrupted.

5229.3 -> And so what's so beautiful about this work

5233.239 -> from the Columbia group, is that what it says

5236.77 -> is the place to intervene has to be the habit.

5240.78 -> This stuff has already passed through all the learning,

5243.3 -> it's passed through all the reward systems.

5245.26 -> It's clearly not being overrun by the homeostatic processes

5248.27 -> of the body.

5249.103 -> There's very little body fat.

5250.118 -> There's no leptin,

5251.64 -> whatever neurons in the brain respond to leptin are starved

5253.97 -> for leptin, periods of shutdown, sperm production,

5257.4 -> and testosterone is lowered.

5259.08 -> Bone density is down.

5260.28 -> Clearly, this is overriding all those homeostatic processes,

5264.38 -> all the signals that would say eat, eat, eat.

5267.24 -> Those don't matter in the brain of the anorexic.

5270.65 -> In the brain of the anorexic is just performing habits

5273.77 -> and they're being rewarded for it.

5275.54 -> So, when you come along and say, look,

5277.55 -> you should really eat this whole pie or this whole pizza

5279.7 -> you'll feel better.

5280.73 -> That's how she aversive to them.

5282.188 -> So, since it appears to be a habit,

5284.57 -> a reflex that's perpetuating the anorexic phenotype.

5288.7 -> As we say, in science,

5289.61 -> it's perpetuating anorexia in this individual

5292.51 -> and telling them about all this terrible stuff

5295.02 -> that's happening in their body won't work,

5297.2 -> taking them away from all the images

5299.07 -> of thin people online, et cetera.

5301.06 -> That's not going to work.

5302.61 -> What's going to work.

5304.04 -> What's going to work is intervening in the neural circuitry.

5307.37 -> That's related to the habit itself.

5310.37 -> And it turns out that there are ways to do that.

5311.917 -> So, how do you break a habit?

5313.84 -> How do you rewire the brain circuitry

5315.63 -> that's literally causing a reflex?

5317.6 -> And in this case causing a reflex

5319.23 -> that is killing the individual,

5321.64 -> or at least leading to very bad health outcomes.

5326 -> The way that you do that is through a cognitive mechanism

5329.71 -> where you teach the individual,

5331.54 -> what is leading up to the habit?

5333.82 -> This is a little bit similar to the way that somebody

5336.45 -> who suffers from addiction starts to put

5339.08 -> in different constraint type behaviors,

5342.32 -> constraint type behaviors,

5343.34 -> are the sorts of things like where the alcoholic

5345.56 -> will call a hotel ahead of time and say, listen,

5347.8 -> I want the mini bar taken out of the room.

5350.8 -> I don't want a television in the room, et cetera,

5352.71 -> constraint type behaviors.

5354.17 -> Those are really ways of keeping oneself

5357.1 -> from the temptation.

5358.71 -> But with these habits,

5360.01 -> they work at such a subconscious level.

5362.33 -> That what seems to work best is a combination of teaching

5366.277 -> the individual about their internal state

5369.96 -> and how to register their internal state.

5371.77 -> What we call interoception this ability

5373.39 -> to perceive your internal state,

5375.49 -> so that they can start to learn,

5378.05 -> to associate the interactions with different types of food,

5381.75 -> with the sorts of cues that are occurring within their body,

5384.88 -> quickening of heart rate,

5386.72 -> hyper acuity of focus that we talked about earlier.

5389.85 -> Once they start to be able to notice that those things

5392.01 -> are happening, then they can start to intervene.

5395 -> So, let's talk about what those things are that lead

5397.94 -> into a habit,

5399.929 -> because those turn out to be the exact points of entry

5402.29 -> for changing and eliminating and rewiring habits,

5406 -> to a more healthy behaviors.

5407.55 -> And I should highlight that this isn't just about rewiring

5411.304 -> habits for sake of the anorexic.

5412.34 -> These are also the same types of mechanisms that one would

5415.08 -> want to incorporate in order to rewire any habit

5418.28 -> of any kind.

5419.43 -> There are two main features of thinking

5421.205 -> that go into the sorts of habits that anorexics execute.

5426.35 -> The first is something called weak central coherence.

5429.49 -> Weak central coherence is essentially an inability

5432.48 -> to see the forest through the trees.

5435.01 -> It's a hyper acuity and focus on details

5438.01 -> within a given environment.

5439.04 -> And there's actually an interesting probe test for anorexia

5442.66 -> that involves something akin to kind of a where's Waldo type

5446.47 -> of puzzle, where an image is put up.

5450.14 -> The one that I saw was one

5451.21 -> in which there is a big array of coffee beans.

5454.11 -> Actually, they're all brown coffee beans.

5455.65 -> And your job is to identify where in that array

5459.69 -> of coffee beans, there's a face.

5461.55 -> And indeed there's a face embedded in there.

5463.71 -> It looks a little bit like a coffee bean,

5464.99 -> but once you see it, you realize it's a face,

5466.6 -> not a coffee bean.

5468.06 -> And it becomes very hard to not notice the face after that.

5473.35 -> Anorexics, are very good at identifying the face.

5477.27 -> They find it much faster than do non-anorexics,

5481.19 -> which is really interesting, right?

5482.97 -> They somehow are able to hone in on details

5485.28 -> and find those details and fixate on those details.

5489 -> Now eventually, most, if not all people find the face,

5492.05 -> but once you do what you will find and what everyone finds

5495.84 -> is that you can't unfine the face, it just jumps out.

5498.55 -> So, what essentially you've lost is the ability

5500.57 -> to see the whole picture,

5502.36 -> because there's some detail within that picture

5504.54 -> that you're obsessed by.

5506.23 -> So, this has kind of elements

5507.48 -> of obsessive compulsive disorder,

5508.9 -> but it's not really obsessive compulsive disorder per se.

5513.278 -> So, we call that weak central coherence.

5515.787 -> It's a hyper acuity on one particular feature.

5518.53 -> You miss the big picture.

5520.24 -> The other is a challenge in set shifting

5522.24 -> that once you identify something

5524.06 -> that's of particular interest and that's driving some sort

5528.573 -> of reward, for the anorexic

5529.87 -> that would be identifying the high-fat foods or identifying

5532.95 -> the one food on the table that one could eat without anyone,

5536.22 -> hopefully noticing that they're eating just the green beans

5539.67 -> and not touching any of the other food.

5541.44 -> If you ever had a meal with an anorexic.

5543.68 -> You might be familiar with this.

5545.45 -> It's kind of uncomfortable to be around.

5547.12 -> Actually they go through a lot of elaborate procedures

5549.74 -> to kind of hide food too.

5551.53 -> They'll sometimes even chew food,

5552.79 -> hold it in their mouth and then go to the bathroom

5554.64 -> and discard it things, very elaborate,

5556.41 -> very troubling types of things to hear about,

5558.147 -> and to be around.

5558.99 -> But you'll notice that they push food

5560.36 -> around their plate a lot.

5561.44 -> They become masterful actually at trying

5563.83 -> to keep people's awareness away from what they're doing,

5566.76 -> which is to hone in on these low fat, low calorie foods.

5570.33 -> And they can't seem to set shift.

5571.83 -> They can't just relax and enjoy the meal, because the meal

5574.85 -> for them is essentially like this where's Waldo

5578.22 -> or find the face in the coffee being tasked.

5580.24 -> They're constantly monitoring how much people are observing

5583.59 -> them and trying to navigate this.

5585.73 -> What would otherwise be a really pleasant circumstance

5588.28 -> for most people they're trying to navigate

5590.13 -> through this because remember for them,

5592.1 -> the reward is in the avoidance of certain things

5594.97 -> and the acquiring of only the foods

5597.41 -> that their brain rewards them for,

5599.16 -> because those are the foods that have been preselected

5601.26 -> and are now habit.

5602.299 -> What's amazing.

5605.25 -> And frankly also important are these findings

5608.01 -> that once you teach anorexics, what's happening to them,

5611.65 -> that they're doing this, they are able to intervene.

5614.702 -> Now they need support, right?

5617.24 -> And another form of therapy that seems to work well

5619.934 -> for anorexics that ideally is combined

5623.32 -> with this habit rewiring, is a family-based model.

5628.01 -> Family-based models are starting to surface a lot now

5630.6 -> in various therapy settings,

5632.43 -> therapy based models in short are basically

5635.39 -> where the entire family is made aware

5637.89 -> of the individual's challenges

5639.54 -> with a particular eating disorder or other disorder.

5642.03 -> And in understanding some of the biology and psychology

5645.08 -> around it, they stopped condemning the individual.

5648.43 -> They start to support that individual through queuing them

5652.01 -> towards their own habits that they observe.

5653.69 -> They give them some autonomy.

5654.96 -> They realize that none of this changes overnight,

5657.22 -> but they're taught about things like neuroplasticity

5659.58 -> and the ability to change one's brain

5661.16 -> in response to experience.

5662.48 -> And so there's a whole internal support network.

5665.55 -> Now, for people that live alone,

5667.4 -> this isn't available to them.

5668.67 -> This isn't the kind of thing that you share

5669.79 -> with your coworkers.

5670.623 -> You might involve a close friend or a spouse,

5673.52 -> but it's not the sort of thing that people that don't live

5676.63 -> in a family context can really benefit from.

5680.85 -> All of these things fall under the umbrella

5683.08 -> of cognitive behavioral therapy.

5684.94 -> And I should mention that cognitive behavioral therapies

5687.34 -> are often done in conjunction with pharmacologic therapies.

5691.03 -> I think that there's this idea out there that it's either,

5694.1 -> or when often it's both.

5696.12 -> So, cognitive behavioral are often combined with this habit

5699.6 -> recognition and rewiring approach,

5702.83 -> which is starting to become more and more common.

5704.94 -> And I think the date on it looked really good

5707.52 -> that especially when it individuals are taught this early

5711.83 -> in adolescence, that there are positive outcomes over time,

5716.242 -> the relapse rate of anorexia is quite high.

5719.02 -> It's about 50% of individuals will relapse at some point

5721.85 -> often triggered by a stressful life circumstance.

5724.4 -> But the combination of cognitive behavioral therapy

5727.57 -> that includes this family model,

5728.984 -> or at least habit reformulation seems

5731.87 -> to be fairly effective.

5733.41 -> And at present might be the most effective treatment.

5736.1 -> Now there are additional treatments starting to surface,

5738.62 -> and that takes us into the realm

5740.53 -> of chemical treatments for anorexia.

5742.79 -> And I just want to mention that there are clinical trials,

5746.71 -> meaning legal clinical trials being done

5748.79 -> at Johns Hopkins School of Medicine by Matthew Johnson

5751.1 -> and others, exploring how drugs like MDMA,

5755.53 -> which increases dopamine and serotonin to very high levels

5758.93 -> or siliciden so-called magic mushrooms,

5762.02 -> which increases serotonin and other compounds

5764.55 -> to very high levels within the confines

5767.35 -> of a professionally supported therapeutic environment

5771.34 -> can help people rewire their brain,

5773.43 -> such that they can get relief from major depression

5776.02 -> and various forms of trauma.

5777.41 -> And now eating disorders are also being explored

5780.93 -> in the context of MDMA and siliciden clinical trials.

5784.99 -> I do want to emphasize that those are clinical trials,

5788.7 -> that those compounds are not yet legal.

5790.75 -> And in many cases, most cases they are still illegal.

5795.02 -> I do not think that they should be explored

5797.89 -> without a properly trained medical doctor,

5802.2 -> that the clinical trials are essential to complete before

5805.22 -> one explores those compounds in particular,

5808.54 -> because lately I get a lot of emails about these compounds.

5811.45 -> People telling me that they've had amazing experiences

5813.98 -> and relief from various things, not just eating disorders,

5816.58 -> but depression, et cetera.

5818.24 -> However, I get an equal number of emails from people saying

5822.59 -> that they worked with some self appointed guide.

5825.129 -> This would be outside the clinical trials I was referring

5827.86 -> to, and they are now experiencing chronic visual, snow.

5832.18 -> They're getting genuine visual field deficits.

5835 -> They are havering ticks that they have never had before,

5838.06 -> they have chronic insomnia.

5839.29 -> So, I'm not passing judgment on any of these compounds

5842.86 -> or the people that are doing this sort of thing.

5844.51 -> I just want to see the clinical data.

5846.75 -> And I do believe that we should wait until these clinical

5849.14 -> trials are done before people start approaching the stuff.

5853.63 -> And that's because they are serious compounds.

5856.7 -> They can open plasticity,

5858.285 -> but whether or not they work quote unquote

5861.599 -> for different types of eating disorders

5863.73 -> or depression and trauma, the data are looking promising,

5867.84 -> but that the clinical trials are still not done.

5870.15 -> And I know a number of people are going out of the U.S.

5872.4 -> and into other countries where this stuff is being done

5875.01 -> more regularly and there too.

5876.86 -> I've gotten reports back of people doing

5878.83 -> so-called ibogaine treatments.

5880.6 -> Some of you who are familiar with eating disorders

5882.93 -> will immediately be asking, well, what about ibogaine?

5885.34 -> Does it work?

5886.624 -> Does it work?

5887.457 -> Well, the clinical trials in this country are not complete.

5890.85 -> I've heard evidence direct.

5892.6 -> I've heard directly from people who have benefited

5896.95 -> from the sorts of things, for treatment of eating disorders.

5899.48 -> But I've also heard of people that have developed chronic

5902.13 -> seizure disorders from pursuing things like ibogaine

5905.65 -> for the treatment of eating disorders.

5908.48 -> So, again, I'm not passing judgment.

5909.88 -> I would just like to see more data.

5911.74 -> And it's very important that the safety aspects

5915.49 -> of safety be in place.

5916.61 -> So, this is definitely not something to get renegade about.

5919.328 -> So, it appears that once anorexia has established

5922.99 -> that habit breaking through self-awareness

5926 -> of what the habits are,

5928.34 -> is going to be a primary entry point.

5930.55 -> That might seem kind of trivial.

5932.023 -> You might say, well,

5933.706 -> could you have just told us that in one sentence,

5935.1 -> but I want to return us to this model

5938.26 -> about homeostatic processes, reward, processes, et cetera.

5943.39 -> That leads us to a place where the short answer is no,

5946.25 -> you can't simply say break the habit.

5949.16 -> An individual needs to be informed

5951.3 -> about where that habit comes from.

5952.877 -> And the fact that what currently seems

5955.59 -> like a rewarded habit should actually be a punished habit.

5960.29 -> Now, I don't mean by actual punishment,

5962.55 -> but what I mean is within the brain,

5964.599 -> there's been a switch and the anorexic needs

5967.042 -> to learn that there's been a switch such that what should

5970.87 -> be rewarding is now punished and what should be punished.

5974.13 -> Starvation is now rewarded.

5976.96 -> The beauty of being a human being is that knowledge

5980.77 -> of knowledge can allow you to make better decisions.

5985.72 -> I'll say that again,

5986.553 -> the beauty of being a human being is that knowledge

5988.53 -> of knowledge can allow you to make better decisions.

5991.02 -> Now, of course, when we are anxious, when we are tired,

5995.61 -> when we are intoxicated,

5998.4 -> we have less access to that ability to use knowledge

6001.79 -> of knowledge, to intervene.

6003.76 -> The anorexic will often do things that are in keeping

6006.99 -> with their habits, such as overexercising.

6009.22 -> This is a area that anyone who's treated anorexics

6012.58 -> or interacted with anorexics is well aware of,

6015.15 -> that they are constantly moving.

6017.26 -> They're constantly on the treadmill.

6018.59 -> They're constantly running.

6019.68 -> They always want to be moving and burning calories,

6022.22 -> so that they can feel okay about interacting

6024.34 -> with food or because they have the distorted body image.

6027.295 -> Well, does breaking a habit mean

6030.98 -> that they should stop moving around and exercising?

6033.36 -> No, not necessarily.

6034.86 -> There's some really interesting studies that show

6036.83 -> that shifting anorexics towards activities

6040.858 -> that for instance, build muscle resistance training

6044.96 -> and allow them to eat a bit more food

6048.09 -> without necessarily losing weight,

6051.7 -> but rather to put more muscle on their body

6054.77 -> can actually be beneficial.

6056.722 -> Now I'm not talking about anorexics becoming bodybuilders,

6058.79 -> has all body dysmorphia associated with bodybuilding,

6061.67 -> but certain forms of exercise are just catabolic.

6064.87 -> Meaning they break down the amount of muscle.

6066.54 -> They reduce body weight, overall,

6068.89 -> other types of exercises like resistance training

6072.03 -> or anabolic, they allow muscle to be put on.

6075.38 -> And there are some interesting studies, not a lot,

6078.26 -> but some interesting studies trying to encourage anorexics,

6081.75 -> not to stop exercising,

6083.13 -> but rather to stop exercising in this neurotic catabolic way

6087.46 -> of breaking oneself down,

6088.93 -> but rather getting them shifted toward breaking habits

6092.61 -> of only approaching low calorie, low fat foods,

6094.87 -> while also encouraging them to embark on resistance training

6097.905 -> and to start to learn and reward the relationship

6101.85 -> between exercise for sake of making one's body strong,

6105.56 -> including the bones, not just the muscles, but the bones,

6108.21 -> which is important, especially in anorexics.

6110.64 -> And then to see food as a way to nourish that process,

6113.84 -> to building a body that could be of the stable weight.

6116.98 -> Hopefully there, once the anorexic is of a healthy weight

6120.05 -> that they're maintaining that weight,

6121.73 -> but that they don't have to constantly be on this treadmill,

6124.35 -> no pun intended of balancing whatever food intake

6128.04 -> they have with activity.

6129.55 -> And along the lines of that.

6132.104 -> During the episode on fat loss and metabolism as well,

6135.45 -> I talked about this neat and non-exercise induced

6139.2 -> thermogenesis where people who tend to be thin,

6142.51 -> tend to bounce around a lot.

6143.82 -> They're kind of fidgety and that burns 1000

6146.694 -> of calories a day, anywhere from 800 to 2000 calories a day.

6148.877 -> Now that can be beneficial for the folks that are overweight

6151.882 -> and have a healthy mindset about food,

6153.96 -> but are trying to lose weight.

6155.43 -> And it turns out that by, you

6158.64 -> literally fidgeting and bouncing around, like,

6160.27 -> this is why I'm doing this.

6161.877 -> It looks ridiculous.

6162.71 -> You actually burn a lot of body fat and calories.

6165.2 -> That way provide you're in a caloric deficit,

6167.32 -> you'll burn body fat because body fat is not just

6169.94 -> a passive tissue.

6170.773 -> It actually receives input from neurons

6172.81 -> that release noradrenaline and adrenaline.

6175.04 -> And this neat.

6176.333 -> Has been described for several decades now.

6179.24 -> And it actually is a pretty terrific way

6180.91 -> to burn off more calories.

6183.83 -> So, with the anorexic,

6184.88 -> you actually want to encourage them to not constantly

6187.62 -> be trying to burn off calories.

6189.61 -> That can be very challenging.

6190.66 -> So, shifting them toward activities like weight bearing

6194.01 -> activities or resistance training that promote

6196.58 -> this more anabolic type of relationship to activity,

6199.98 -> as opposed to catabolic can be beneficial.

6202.14 -> Before we move on to talking about bulimia and some related

6204.88 -> disorders, I want to talk about an aspect of anorexia.

6207.5 -> That's very interesting, quite troubling in fact,

6210.85 -> but that has received a lot of attention

6214.36 -> and that's the distorted self image.

6218.11 -> Now, episode and depression,

6220.89 -> we talked about a very powerful aspect of major depression,

6225.72 -> which is this anti-self confabulation that people

6228.05 -> who are depressed seem to genuinely believe.

6231.45 -> And even confabulate about the fact

6233.28 -> that they are performing poorly in life

6235.11 -> and that they are no good or not, or worthless, et cetera.

6238.11 -> It's literally a lie that they believe and their statements

6242.41 -> and their feelings and their behaviors start

6244.14 -> to reflect that lie.

6245.59 -> They're not conscious of it.

6246.51 -> That's why we call it a confabulation.

6249.89 -> Anorexics often will see themselves as overweight

6255.04 -> or imperfect in ways that are of an obsession for them,

6258.83 -> they'll think, oh, you know,

6259.663 -> their arms are a little bit fat, you know,

6262.34 -> or, you know, the contour,

6264.01 -> their face makes they don't like the pictures

6266.51 -> of themselves or they.

6268.07 -> What I'm describing here is actually pretty typical behavior

6270.69 -> of a lot of people.

6271.75 -> I mean, how many people do you know that after you take

6273.49 -> a picture of them, they say, can I see the picture?

6275.43 -> And then they tell you that you have to throw it away.

6277.61 -> That doesn't necessarily mean they're anorexic

6279.43 -> or they're suffering from some sort of disorder.

6281.4 -> That just means that they're a human being that cares

6283.51 -> about how they appear in the world.

6285.6 -> We're not here to judge that in the case of the anorexic.

6288.96 -> The problem seems to be that they have a genuine distortion

6293.11 -> of their self image so much so that they don't actually see

6297.93 -> themselves accurately, their visual perceptions are off.

6301.89 -> And the reason we know this,

6303.003 -> it's because of some really important

6305.19 -> and beautiful studies that were done with my colleague,

6308.908 -> Jeremy Bailenson's lab at Stanford,

6310.06 -> he's in the department of communications,

6311.72 -> he's actually collaborated

6312.81 -> with a Dr. Halpern that I mentioned earlier.

6315.19 -> What's really interesting about these studies is they give

6317.24 -> us a window into the perceptual defect that anorexics have.

6320.876 -> I've actually done one of these experiments.

6323.5 -> I'm fortunate to not be anorexic,

6325.06 -> but I've done some work with the VR lab over there.

6327.894 -> And what you get to do is you get to adjust this avatar

6331.073 -> of yourself to the point where you think it's,

6332.46 -> as accurate as it could possibly be,

6334.66 -> and anorexics, really distort this avatar.

6339.26 -> In other words,

6340.093 -> they create this serious mismatch between their perception

6343.54 -> of themselves and the reality.

6344.82 -> So, indeed it does seem to be the case now what's relieving,

6349.03 -> or I should say what's encouraging

6351.41 -> about some of the therapies that we talked

6353.28 -> about before the family based model,

6354.77 -> the Connie behavioral treatments.

6357.296 -> Yes, and the drug treatments as well.

6359.63 -> But this habit intervention model is that as one starts

6363.99 -> to shift those things,

6365.72 -> it does appear that the perception of self seems

6368.47 -> to follow that the perception of self seems

6371.079 -> to shift along with the change in habits.

6374.37 -> And that's a relief,

6375.595 -> or at least I find that reassuring

6377.36 -> because changing one's perception is actually very hard,

6381.75 -> as somebody who's worked almost his entire career

6384.03 -> on visual perception and related things.

6386.53 -> The perceptual apparatus of the brain are not very amenable

6391.52 -> to neuroplasticity, meaning they don't change that easily.

6394.57 -> Whereas it appears that the circuitry

6397.09 -> that's related to habit formation, and decision-making

6399.287 -> and the reward, circuitry, that stuff can be rewired.

6402.95 -> And so anorexics as they progress

6405.04 -> out of their anorexic state into one,

6407.95 -> which they are intervening in their reflexes,

6411.27 -> gaining better habits around food, eating more,

6414.81 -> more accurately, assessing foods

6417.92 -> and environments that they're in related to food,

6420.47 -> as they change their behavior.

6421.64 -> And they start to put on healthy weight,

6423.14 -> maybe they're also doing the sorts of exercises that allow

6425.39 -> them to put on healthy weight and avoiding kind

6427.92 -> of extreme exercises of cannibalism

6430.2 -> and breaking themselves down.

6431.6 -> They also managed to somehow just as a consequence

6435.35 -> of all that rewire their perception of self.

6438.46 -> So, it doesn't seem that trying to tell someone,

6440.62 -> oh my gosh, you're so thin.

6442.29 -> You really need to eat.

6443.4 -> That doesn't seem to work.

6444.92 -> They just don't see themselves the same way

6447.7 -> that you see them.

6448.76 -> And so I offer that as a point of consideration,

6451.59 -> if you know someone that's anorexic,

6452.94 -> or if you look at an anorexic and you think,

6455.01 -> how is it that they are still critical of the small,

6458.77 -> even nonexistent amount of body fat

6460.62 -> on their triceps or something?

6462.07 -> How is that?

6462.95 -> Well, it's literally that their brain,

6465.37 -> as it relates to perceptions,

6466.76 -> visual perceptions in particular, they're completely off.

6470.17 -> And fortunately by changing habits,

6472.13 -> you rewire those circuits as well.

6474.24 -> Okay, so let's talk about bulimia,

6475.718 -> which is overeating and then purging typically

6481.32 -> by self-induced vomiting or by ingestion

6483.97 -> of laxatives, sometimes also in concert

6487.1 -> with people taking stimulants and fat burners,

6491.28 -> over ingestion of stimulus to try and burn off more energy.

6493.821 -> And then we'll also talk about binge eating disorder,

6496.85 -> which has a lot of the same features as bulimia,

6500.01 -> but typically no purging.

6503.43 -> I'm not going to list off all the clinical criteria

6506.47 -> that would allow someone to be diagnosed as bulimic

6510.45 -> or binge eating disorder.

6512.47 -> But the general features are that they ingest far more

6515.52 -> calories than they need, anywhere from 10 to 30 times,

6520.99 -> their daily caloric intake,

6522.36 -> oftentimes within a two hour period,

6525.21 -> which is just a staggering amount of food and nutrients

6529.09 -> in a short period of time.

6530.85 -> Oftentimes they're overriding those mechanical signals

6533.51 -> from the body that they're full.

6534.848 -> It's a really troubling thing to think about,

6538.78 -> but people are literally gorging themselves with food.

6541.01 -> This looks a lot like a laboratory animal

6545.13 -> that has these AgRP neurons stimulated,

6547.292 -> these neurons that will eat

6548.64 -> until they almost burst or burst.

6551.43 -> So, you wonder is that these AgRP neurons that are active

6553.88 -> almost certainly yes.

6555.07 -> That they're involved.

6556.24 -> Although I don't think that that's going

6557.68 -> to be the major point of intervention,

6560.604 -> but we're going to talk about other types of interventions.

6563.72 -> There are a number of clinical criteria.

6565.35 -> For instance, if somebody has one of these binges

6568.34 -> once a year, does that make them bulimic?

6570.86 -> Technically, no, but I certainly

6574.45 -> don't recommend people do this.

6576.252 -> If you are one of these people

6578.56 -> who has so-called cheat days, right?

6580.73 -> Some of you may be familiar with cheat days.

6583.07 -> I think they're a little less common now,

6584.38 -> but the idea is you eat clean for six days

6587.65 -> or five days a week or two weeks.

6589.47 -> And then you have a so-called cheat day where you just kind

6591.32 -> of go wild and eat whatever you want and whatever volumes

6593.815 -> is that bulimia.

6595.11 -> And it has some of the contour of bulimia.

6598.38 -> If you're vomiting afterwards or binge eating disorder,

6600.8 -> if you're not,

6601.88 -> does it constitute full blown bulimia

6603.76 -> or binge eating disorder?

6604.9 -> And it's pretty hard to say,

6606.391 -> the criteria that were described

6607.96 -> to me is that if somebody is doing this at least once

6610.89 -> a month, over a period of anywhere from two to three months,

6613.87 -> then it likely would qualify.

6616.24 -> And I certainly know people who do these cheat days

6619.05 -> and by those criteria,

6621.32 -> they have something like binge eating disorder.

6623.84 -> But in general,

6624.784 -> one of the hallmark features of bulimia binge eating

6628.926 -> disorder is that people are unable to control their eating.

6631.92 -> They're just simply,

6632.81 -> they're not making the decision to have a cheat day.

6635.44 -> They're not making the decision to overeat.

6637.92 -> They are simply driven from the inside without question

6643.34 -> by way of neurocircuitry.

6645.57 -> They are driven from the inside to ingest far more food

6650.12 -> than they need.

6651.31 -> And in some cases than they would want to eat.

6654.17 -> So, it's a lot like the habit

6656.5 -> that we described for anorexia,

6658.7 -> it's almost like it's turned into a reflux once

6661.946 -> they get going, all the homeostatic signals

6663.89 -> are being overridden, all the signals from the body,

6667.13 -> the leptin, the insulin, the glucose,

6670.23 -> all that stuff has cosmically sky high.

6672.28 -> And yet they're just what we,

6674.221 -> the nerds call hyperphagic, they're just eating like crazy.

6680.716 -> So, what's going on there?

6681.549 -> Well, there've been a lot of ideas,

6683.303 -> about why this arises.

6686.54 -> There's the so-called thyroid hormone hypothesis.

6690.53 -> That one's a tricky one.

6691.81 -> It turns out that cortisol

6693.71 -> and thyroid hormone concentrations vary according

6697.08 -> to when the binge purge happened.

6700.35 -> So, there were some studies that looked

6701.92 -> at thyroid hormone levels

6703.189 -> and they found elevated thyroid hormone levels.

6707.11 -> Thyroid hormone is involved in metabolism

6710.33 -> and not just the burning of energy,

6711.94 -> but the use of energy in converting it to different tissues

6715.62 -> of the body, cartilage bone, fat, and muscle, et cetera,

6720.255 -> did a whole episode on thyroid and growth hormone.

6722.59 -> By the way,

6723.709 -> if you're interested in learning more about thyroid hormone,

6727.47 -> but thyroid hormone can also be depleted at other phases

6731.22 -> of the binge purge cycle.

6732.76 -> Now, without listing off all the terrible things

6736.02 -> that happen with this binge purge cycle,

6738.24 -> there are a number of things

6739.32 -> that are really worth pointing out.

6741.44 -> One is that the vomiting itself,

6743.563 -> the use of laxatives that can cause severe disruption

6747.22 -> to the mucosal lining the mucus lining

6749.91 -> of the digestive tract can severely disrupt

6752.46 -> the gut microbiome.

6754.13 -> It can cause all sorts of even a ulceration of the esophagus

6759.32 -> and just really terrible stuff.

6762.2 -> There's a lot of shame associated with bulimia,

6765.74 -> oftentimes because people are vomiting and it's hard to hide

6770.06 -> that vomiting behavior, people are aware of it.

6773.1 -> There's some social isolation.

6774.564 -> So, you recall from the beginning,

6775.9 -> it does not appear that sexual trauma

6778.42 -> is a prerequisite for bulimia.

6780.59 -> Although sometimes it can occur the hallmark feature

6783.29 -> of bulimia that distinguishes it from anorexia,

6786.83 -> aside from the fact that it's overeating as opposed

6788.76 -> to under-eating is a lack

6790.68 -> of what they call inhibitory control.

6792.82 -> And that might come as no surprise.

6794.358 -> But first of all, the bulimic,

6799.16 -> unlike the anorexic is hyper impulsive and oftentimes

6804.75 -> has other types of impulse behaviors.

6806.67 -> They might have a little bit of alcohol

6808.6 -> and then start to eat like crazy.

6810.55 -> Whereas normally they're very restrictive.

6812.06 -> That's a common feature of bulimia,

6814.83 -> sometimes they over ingest alcohol during these binges.

6818.19 -> Sometimes they are sexually promiscuous, not always,

6821.98 -> but it's a general issue with satiety

6825.2 -> once they start eating and with impulse control generally.

6828.8 -> And for that reason,

6829.951 -> many of the treatments that you see for bulimia

6832.41 -> and binge eating disorder are the sorts of treatments

6835.17 -> that don't seem to work so well,

6837.54 -> or at least most of the time for anorexia.

6840.2 -> So, the drugs that increase the neuromodulator serotonin,

6843.15 -> for instance, fluoxetine

6846.89 -> also called Prozac, Paxil, et cetera.

6849.62 -> Those things oftentimes can be effective in bulimia.

6853.89 -> Some of the drugs that are used to treat attention deficit

6856.33 -> hyperactivity disorder an ADD, a topic that we're going

6858.87 -> to talk about in depth here on the podcast soon,

6862.33 -> some of those same drugs like Adderall,

6865.437 -> Vyvanse and things of that sort can also be used

6869.1 -> to treat bulimia and binge eating disorder.

6871.67 -> Why would that work?

6872.63 -> Well now you are familiar with the prefrontal cortex.

6875.29 -> You probably know more about prefrontal cortex

6876.79 -> than you ever wanted to, just from this episode,

6880.164 -> prefrontal cortex is involved in this analysis of duration

6884.45 -> path and outcome.

6885.436 -> Duration path and outcome is how we avoid impulsivity.

6889.97 -> It's how we think.

6890.803 -> Okay, if this, then that, if that, then this,

6892.95 -> you can imagine how for the obsessive compulsive

6894.87 -> or for the anorexic, these are circuits that are overactive.

6899.42 -> For the bulimic this is the circuit that's going

6903.08 -> to essentially be underactive and is under conditions

6906.42 -> where they think, oh, you know, I shouldn't eat anything.

6908.66 -> I shouldn't eat anything.

6909.493 -> And then they just tear the refrigerator open

6912.16 -> and plow through that.

6913.55 -> And then at that point they're plowing through the cupboards

6916.23 -> and then they're ordering food.

6917.36 -> And then they're feeling horrible about themselves.

6919.41 -> There do tend to be these cycles of binge and purge followed

6923.51 -> by feelings of real shame

6926.02 -> because they just can't control their behavior.

6928.7 -> And what is more embarrassing than not being able to control

6932.327 -> one's behavior as an adult or as a young adult.

6934.66 -> So, really the polar opposite of what you see in anorexia.

6938.61 -> So, this lack of impulsivity implies

6941.27 -> a lack of prefrontal control.

6943.04 -> What we call top-down control.

6944.23 -> Why do we call it top-down?

6945.09 -> Because the prefrontal cortex is suppressing

6947.01 -> the activity of deeper limbic and hypothalamic circuitry,

6951.99 -> and things of that sort.

6953.62 -> Anytime you feel like you want to say something

6956.69 -> really offensive and you don't, that's top-down control.

6961.74 -> That's your prefrontal cortex.

6963.15 -> Anytime someone says something

6964.63 -> and you like grow your teeth.

6967.16 -> 'Cause you'd know you shouldn't say anything,

6968.88 -> gritting your teeth is top-dow control, okay?

6971.67 -> When you explode or burst or say the wrong thing,

6975.08 -> or say the thing that you shouldn't say or do the thing

6978.15 -> you shouldn't do, that's lack of prefrontal control.

6980.29 -> And indeed people who have frontotemporal dementia

6982.69 -> due to aging or head injuries,

6984.282 -> see this a lot and people play sports get

6987.3 -> a lot frontal damage.

6989.68 -> They become more impulsive.

6991.26 -> So, bulimics have an issue with impulsivity,

6995.63 -> and therefore drugs that can increase serotonin.

6999.58 -> And sometimes these drugs that increase dopamine

7002.45 -> and adrenaline also called epinephrin,

7005.17 -> will increase the tone as we call it the dopaminergic tone

7009.32 -> or the, it's called adrenergic,

7012.25 -> but norepinephrine levels in the brain allow

7014.93 -> for more top-down control.

7016.33 -> And that's also why they're used to treat ADHD

7018.87 -> and attention deficit disorder.

7021.35 -> They tend to create a hyper-focus.

7023.6 -> They tend to push the brain into,

7025.67 -> these drugs tend to create a hyper-focus,

7027.23 -> and tend to push the brain and general motor processing

7030.1 -> into one in which you think if this, then that, if this,

7032.95 -> then that, so anticipating outcomes.

7035.29 -> And for that reason, drugs like Wellbutrin, bupropion,

7040.21 -> which is an antidepressant,

7041.31 -> which mainly increases the amount of dopamine

7043.99 -> and norepinephrine and less serotonin,

7046.78 -> that can also be effective for certain types

7048.72 -> of binge-eating disorder is actually used

7051.996 -> to treat smoking, for promoting smoking cessation

7055.09 -> and for depression, but also for certain forms

7059.17 -> of obesity related to binge eating disorder.

7061.6 -> And the data are pretty good.

7062.74 -> And there are timed release forms

7064.17 -> of this and non-time release forms.

7065.66 -> And I think you have to consult with a psychiatrist in order

7069.49 -> to get these prescribed because they are prescription drugs,

7071.93 -> but it's a very different constellation of neurochemicals

7075.24 -> and brain areas and approaches for bulimia.

7079.24 -> The treatment of binge eating disorder has been explored

7082.58 -> from a new standpoint recently.

7085.3 -> And that's the work of this now,

7087.59 -> sadly, former colleague of mine, Dr. Casey Halpern,

7090.38 -> who's at University of Pennsylvania

7093.763 -> that I mentioned earlier,

7094.8 -> they are using deep brain stimulation

7097.45 -> in order to treat binge-eating disorder.

7099.8 -> Now why deep brain stimulation?

7101.69 -> Well work from Dr. Halpern and others while

7105.85 -> at Stanford showed that there are particular patterns

7109.35 -> of brain activity in both the prefrontal cortex,

7113.32 -> but also in an area of the brain

7114.96 -> called the nucleus accumbens,

7116.61 -> very important and very relevant area of the brain

7120.28 -> in this context,

7121.16 -> and in any discussion about motivated behaviors

7125.14 -> of any kind, feeding, sex, drug relay behavior,

7127.613 -> people exercise compulsively,

7130.932 -> the nucleus accumbens is in a ongoing dialogue

7134.67 -> with the prefrontal cortex and the nucleus accumbens

7136.599 -> has no mind of its own, but it's associated

7139.104 -> with dopamine release.

7140.45 -> It's part of this so-called reward pathway.

7143.51 -> And what Dr. Halpern and colleagues discovered

7146.58 -> is that there are particular patterns of activity

7149.21 -> that ripple through the brain,

7151.15 -> through these prefrontal networks and through

7153.3 -> this nucleus accumbens area, those areas are connected.

7157.35 -> It's called Delta oscillations,

7159.01 -> Delta, just being a particular frequency

7161.33 -> of electrical activity for your aficionado

7163.72 -> as wonderful heart activity.

7166.41 -> But in any case,

7167.975 -> those Delta oscillations in the nucleus accumbens

7170.89 -> are associated with food reward in both mice and humans.

7175.09 -> Somehow this reverberatory activity creates a perception

7179.55 -> in the individual that food is hyper rewarding.

7183.677 -> And that's interesting, and has allowed them

7186.642 -> to use a targeted deep brain stimulation approach

7188.85 -> to treat binge-eating disorder.

7190.77 -> And this deep brain stimulation is appearing

7193.85 -> to be an effective treatment.

7195.4 -> There's still more studies that need to be done.

7197.91 -> Actually, if you think you have binge-eating disorder,

7201.67 -> you can find the criteria for that.

7204 -> And you could contact Dr. Halpern he's.

7206.62 -> As I mentioned, he's moving to University of Pennsylvania.

7208.67 -> They are recruiting patients for these studies all the time.

7211.867 -> The studies are fairly invasive.

7213.64 -> They involve a FDA approved approach of literally placing

7218.4 -> a wire down into an area of the brain that,

7222.83 -> and allows the individual to stimulate a particular brain

7226.52 -> area to offset some of these activity patterns

7230.1 -> that lead to a elevated sense of reward from food

7234.5 -> and binge eating.

7235.78 -> And the data looked really promising.

7237.46 -> Now I realize that's a very invasive approach.

7239.72 -> Not everybody is going to be willing

7242.08 -> to have this wire inserted into the brain,

7244.53 -> but for people that suffer from binge-eating disorder.

7247.12 -> This is a great and very exciting potential treatment.

7252.33 -> Because what I didn't tell you is that many people

7254.65 -> have binge eating disorder are obese

7257.18 -> to the point where their health is greatly risk.

7259.84 -> Now, obesity causes all sorts of shifts in the dialogue

7264.7 -> between the brain and body.

7266.49 -> Some of which you'll recognize from earlier

7268.96 -> in the discussion, for instance,

7270.587 -> leptin signaling is disrupted.

7273.61 -> So, the fat there's lots of body fat,

7276.21 -> but even though that body fat is secreting,

7278.57 -> this hormone leptin in that signal should shut down

7281.61 -> the desire to eat.

7282.567 -> The receptors to leptin in the brain are totally screwed up.

7286.68 -> And so the signal to eat is there,

7289.1 -> but the signal to stop eating is not there.

7291.4 -> So, again, you have an accelerator and a brake,

7293.1 -> and it's like, the accelerator has always pushed down.

7295.177 -> Some of these brain stimulation approaches seem

7297.59 -> to be able to bypass some of that,

7299.72 -> and of course there all the metabolic syndromes

7302.07 -> and the problems with having excess levels of body fat,

7305.75 -> things like insulin resistance, type two diabetes.

7308.66 -> I mean, as disturbing as is to here,

7311.921 -> there are many individuals, actually,

7313.82 -> I know some who are so obese

7317.6 -> that they start getting bodily sores.

7319.75 -> They're not just bedsores,

7320.7 -> but they have skin sores that are very disruptive to them.

7325.06 -> They don't like having these sores.

7326.84 -> And in addition to that,

7329.603 -> they can get peripheral neuropathies

7330.575 -> because of some of these metabolic issues.

7332.93 -> They're not getting enough utilization

7336.04 -> of the nutrients in the tissue,

7337.88 -> because the way that insulin has disrupted insulin singling,

7341.55 -> and they actually have to have certain portions

7343.48 -> of their limbs amputated, and yet they continue to overeat.

7346.59 -> So, this is not an issue of self-control that can easily

7350.85 -> be dealt with simply by telling the person, look,

7352.9 -> you have to stop eating or you're going to die,

7354.94 -> or you're going to have your legs amputated.

7356.95 -> Like with anorexia,

7358.64 -> there's a distortion in the relationship to food,

7361.85 -> but the homeostatic and the reward aspects are disrupted.

7365.85 -> So, unlike anorexia,

7367.11 -> where it seems to be a habit based mechanism

7370.17 -> with bulimia and binge eating disorder,

7373.2 -> something deep within the neural circuitry is causing food

7377.139 -> to be hyper attractive and the break is off.

7380.15 -> So, if you want to develop some empathy

7382.17 -> for what these people are dealing with,

7383.6 -> consider this, it's like driving a car,

7386.48 -> you get onto a grade, maybe a 10 or 15 degree grade,

7390.64 -> and you're heading down and you figure, well,

7393.67 -> you'll just pump the brakes a little bit,

7395.3 -> but there is no break, right?

7396.81 -> So, you start going faster and faster and faster.

7398.93 -> And your only choice is to use the accelerator

7400.82 -> just to coach through it.

7401.7 -> That's essentially what's happening

7402.97 -> to these neural circuits.

7404.5 -> So, the work of Dr. Halpern and others,

7406.42 -> I think is really exciting.

7408.17 -> And even though it's highly invasive,

7409.87 -> I think is going to lead to not just some relief

7414.081 -> for the patients that do get that deep brain stimulation,

7416.407 -> but also the identification of what sorts of receptors

7418.41 -> are present in those brain areas.

7419.845 -> That could help.

7421.52 -> What that means is that once we understand which brain areas

7426.688 -> are involved in disorder, and we understand what receptors,

7429.26 -> those brain areas express,

7431.43 -> then there can start to be additional interventions

7434.12 -> by way of non invasive treatments,

7436.88 -> things like drug treatments,

7438.85 -> do behavioral interventions work for bulimia?

7441.4 -> In some cases, yes,

7442.365 -> provided that those interventions are done early enough.

7447.32 -> Regardless, behavioral interventions,

7449.36 -> coupled with drug based interventions

7451.07 -> are always more effective than either one alone.

7453.37 -> Fortunately, there is a decent size kit of drugs

7457.15 -> that can help with bulimia.

7458.12 -> I mentioned some of them before things

7459.65 -> like bupropion, Welbutrin some of the serotonergic drugs

7463.49 -> and some of the drugs used to treat impulsivity.

7466.16 -> So, we have on the one hand anorexia,

7469.86 -> which seems to be a disruption in habit and a coupling

7472.72 -> of unhealthy habits in this case,

7475.71 -> food restriction to the reward pathway.

7479.21 -> And on the flip side,

7480.41 -> we have binge eating disorder and bulimia

7482.83 -> where a very unhealthy habit of gorging oneself

7485.58 -> with food sometimes followed by purging,

7488.11 -> is not necessarily coupled to reward.

7489.98 -> They feel terrible when they do that, right?

7492.04 -> The anorexic feels great about restricting

7494 -> their food intake.

7494.96 -> They feel like they're winning some sort of game.

7497.05 -> The circuitry is flipped somehow that way.

7499.765 -> With bulimia they feel horrible about the fact

7503.81 -> that they're bingeing, there's immense shame.

7506.01 -> They can't control themselves.

7508.07 -> The reward is set up before the behavior,

7510.98 -> the reward is set up in drawing them to food

7515.05 -> and in making food look like something

7517.15 -> that's incredibly appetizing and there's no impulse break.

7521.46 -> There's no way for them to stop that kind of behavior.

7524.14 -> So, really kind of troubling thing to think about.

7526.21 -> In either case,

7527.6 -> I think for those of us that know anorexics

7530.05 -> or have observed anorexia,

7531.423 -> it's so hard to see somebody starved themselves

7534.13 -> to near death or to death.

7535.7 -> What more could be disturbing?

7537.81 -> Well, equally disturbing is somebody who has an abundance

7541.99 -> of food and is gorging themselves,

7543.56 -> and then feels terrible about it.

7545.406 -> So, these are heavy topics.

7548.475 -> These are topics that frankly no one really wants

7552.38 -> to talk about unless they know someone who is suffering

7554.44 -> from them, or they themselves suffer from them.

7556.98 -> What I've tried to do today is try and give you a window

7559.234 -> into what really underlies these things

7562.74 -> that we call eating disorders.

7565.12 -> I hope I've done that at the level

7566.41 -> of biology neurocircuitry mechanism endocrinology,

7569.65 -> and some of the psychology,

7572.35 -> as with any episode of this podcast.

7574.14 -> But especially in this month where we're talking

7576.14 -> about mental health issues and mental health disorders,

7579.36 -> behavioral disorders, there's no way that I can exhaustively

7583.25 -> cover all the different forms of treatment.

7585.14 -> You have the modely approach,

7586.46 -> you've got all these different approaches to depression,

7590.61 -> into anorexia, et cetera.

7591.63 -> What I've tried to do is give you a framework.

7593.9 -> And in doing that,

7594.733 -> I've tried to give you a framework of understanding

7596.7 -> that also applies to this question.

7599.12 -> That's I think equally important and goes alongside

7602.58 -> the treatment of eating disorders

7603.82 -> is what in the world is healthy eating.

7606.26 -> What in the world is a healthy relationship to food.

7608.69 -> I like to think that I have a healthy relationship to food.

7610.17 -> I know the foods I like.

7612.22 -> I enjoy them.

7613.26 -> They're 10 or 15 foods in particular that I liked very much.

7616.12 -> I've mentioned a few of them on the podcast before,

7618.25 -> and I was sort of amused, surprised and perplexed as to why.

7624.49 -> For instance, I do enjoy eating butter, not in huge amounts,

7627.72 -> but I do like butter.

7629.34 -> So, that seemed to be pretty triggering for folks out there.

7633.28 -> A small selection of people decided that the ingestion

7635.52 -> of butter was a health concern.

7637.5 -> Look to me,

7640.09 -> ingesting butter in small quantities is something

7643.1 -> that I'm comfortable with.

7643.96 -> And my blood lipid profiles feel good.

7646.29 -> They look good to me.

7647.75 -> For other people that might not be the case.

7649.98 -> For some people.

7650.813 -> The idea of eating an animal-based food is probably

7654.58 -> so repulsive that it actually

7657.7 -> can make them feel physically sick.

7659.39 -> And I think that we should be aware that that kind

7662.41 -> of mental phenotype exists.

7663.84 -> I'm not calling it a pathology for other people like myself,

7666.71 -> things like butter and meat feel healthy.

7668.89 -> Now, what quantities?

7670.02 -> Well, I enjoy eating very much.

7671.93 -> I'm not shy about this.

7672.9 -> I've talked about on the podcast before, I enjoy eating.

7675.744 -> Some people have a very complicated relationship to food.

7680.11 -> They don't think of it as nourishment.

7681.76 -> They don't enjoy it socially.

7682.96 -> It's a stressful thing for them based

7685.57 -> on their personal history,

7686.96 -> or maybe just general anxiety around food.

7690.76 -> And I hope that in sharing this information about the fact

7693.97 -> that anytime we approach food, these neurons in our hype,

7698.28 -> in the arcuate area of our hypothalamus actually increase

7702.05 -> our levels of anxiety.

7703.051 -> This is related to that point that Dr. Halpern made,

7704.93 -> which was that from an evolutionary standpoint,

7707.018 -> it is advantageous to ingest as much food

7710.17 -> as often as possible, as quickly as possible.

7712.56 -> We now know that to not be healthy in this age of abundance,

7715.3 -> where calories are essentially everywhere.

7719.58 -> And yet a lot of people feel anxious in anticipation

7725.48 -> of a meal.

7726.313 -> What could be useful to them?

7727.38 -> Well, whether or not they have an eating disorder or not.

7730.27 -> It's very clear that developing methods to calm oneself

7733.97 -> in the presence of any anxiety or fear inducing stimulus

7737.14 -> can be beneficial.

7737.99 -> I've talked about some of these episodes related to stress,

7740.85 -> things like the physiological side to inhale through

7742.84 -> the nose and a long exhale,

7744.153 -> things like mindfulness meditation certainly can help.

7747.25 -> There are data, a lot of studies out there showing

7749.26 -> that meditation practice can help people deal

7751.51 -> with eating related anxiety and disorders.

7754.51 -> I think as a general rule,

7755.64 -> trying to avoid approaching a meal or sitting down

7758.73 -> to eat in an anxious state is probably a good idea,

7761.98 -> but let's be realistic.

7762.91 -> How often can we do that?

7764 -> I think most of us are going to have circumstances

7767.1 -> where we're rushing around trying to just eat before we head

7770.01 -> out or get to a meal.

7771.21 -> And then we sit down and we find ourselves eating.

7772.473 -> This is one of the first times in human evolution

7775.98 -> where we mostly eat out of a desire to consume food,

7781.11 -> not out of a need for food.

7783.14 -> Most everybody could go a fairly long period

7786.54 -> of time, just ingesting water and electrolytes.

7789.3 -> And not that I'm suggesting people do that,

7790.84 -> but let's face it.

7792.22 -> We largely eat nowadays because of a desire to eat,

7795.22 -> not a need to eat,

7796.76 -> and yet we need to eat on a fairly regular basis.

7799.8 -> And so no topic is more complicated

7803.54 -> and nuanced than food and nutrition.

7806.57 -> And in particular, as it relates to eating disorders.

7808.67 -> So, the major takeaways today are,

7812.03 -> we should all be asking the question,

7813.19 -> what is healthy eating for us?

7815.24 -> How do we develop a relationship

7816.84 -> to food that we can enjoy food, hopefully both socially

7820.64 -> and on our own, but that we are not neurotic

7823.9 -> and compulsive about it.

7824.91 -> For those of you that intermittent fast,

7826.55 -> this also applies, right?

7828.2 -> What, you know, God forbid,

7830.886 -> if you eat 30 minutes before your eating window starts,

7832.09 -> what does that mean?

7832.93 -> If it means something catastrophic,

7834.89 -> do you have an eating disorder?

7836.06 -> I don't know.

7837.448 -> Maybe you have an anxiety disorder,

7838.7 -> that's for you to explore.

7840.62 -> If you don't manage to eat five meals a day

7844.05 -> and that's your obsession.

7845.09 -> Well, then, you know, the same thing applies.

7847.86 -> These are questions that we can all ask ourselves.

7850.15 -> Today, we focus on the extremes of food related behaviors

7854.6 -> that really qualify as genuine disorders.

7857.97 -> They are in the psychiatric manuals and they are diagnosable

7861.94 -> and they are serious health concerns.

7864.98 -> They're not just mentally troubling and concerning

7867.46 -> for the people suffering from them

7868.477 -> and the people around them,

7869.78 -> but they are genuine health concerns,

7871.426 -> just want to reiterate,

7873.1 -> that interaction nervosa is the most deadly psychiatric

7876.87 -> disorder by a huge margin.

7879.8 -> And if you look statistically at the number

7881.95 -> of people with eating disorders and that die

7883.96 -> of eating disorders,

7885.69 -> it's not far off from the number of people

7887.73 -> that die from automobile accidents.

7889.536 -> I know that that sounds like a ridiculous number,

7891.98 -> but you can look this up.

7893.498 -> This is particularly true in certain countries, why that is,

7896.1 -> we don't know, but again, this is not a new phenomenon.

7900.06 -> This is not just related to body image issues

7904.48 -> that are created through social media.

7906.144 -> And as a final point on that,

7908.796 -> many of you are probably asking what about plastic surgery?

7913.6 -> What about all the steps that people are going through?

7916.557 -> Excuse me, to preen themselves and change themselves.

7919.49 -> Are people addicted to plastic surgery?

7921.81 -> Is that a form of body dysmorphia?

7924 -> And indeed it is.

7925.932 -> And so we will do an episode on exercise related

7928.48 -> and plastic surgery related body dysmorphia.

7931.95 -> I think there is very little question that those types

7936.53 -> of disorders are clearly related to what we're observing

7941.55 -> in social media and in media,

7943.66 -> that this shift of, for instance, action heroes.

7947.1 -> If you look at action heroes in the '80s,

7949.2 -> there were very few men that were very large.

7951.55 -> You had your terminate,

7952.383 -> you had your stallone's in your shorts and eggers

7954.92 -> and a few others, but the men in movies tended to be,

7958.23 -> if they were muscular,

7959.09 -> they were far more svelte than they are now.

7961.7 -> There's this kind of, there's a,

7963.842 -> literally a hypertrophy of the imagery.

7965.41 -> And likewise there's been hypertrophy

7968.52 -> of the female body shape.

7970.18 -> As it's portrayed in the media.

7971.53 -> There are body dysmorphia that are related

7975.3 -> to those types of things.

7976.58 -> And that relate to things like plastic surgery,

7978.9 -> steroid abuse, diet, drug abuse, and so on.

7983.54 -> Definitely important to think about and consider,

7986.48 -> and definitely deserving of its own episode.

7988.665 -> You've learned a lot of neuroscience today.

7992.11 -> I hope that was useful in thinking about these disorders

7994.79 -> and in thinking about other aspects of feeding

7997.44 -> and motivated behaviors,

7998.89 -> I would love for you to take away this model

8001.73 -> that was handed off to me,

8002.7 -> that I think is so powerful for thinking

8004.5 -> about all sorts of things, not just eating,

8006.55 -> but all kinds of behaviors and perceptions

8008.3 -> that you have one box for what you think,

8011.56 -> one box for what you do

8013.25 -> and what is intervening between those?

8015.37 -> Why is it that you can know better and not do better?

8017.558 -> Well it's because you also have to cope

8020.73 -> with the subconscious homeostatic processes

8023.66 -> and reward processes.

8025.07 -> And those oftentimes can be disrupted in ways

8028.55 -> that we find ourselves doing things that are not good

8031.9 -> for us or not good for other people.

8033.29 -> But fortunately, there is this great gift,

8035.319 -> which is that knowledge of knowledge can allow you

8038.88 -> to do better without question.

8041.58 -> And that knowledge of knowledge allowing you to do better

8045.55 -> over time leads to this incredible phenomenon

8048.04 -> called neuroplasticity, which essentially is translated

8050.77 -> into doing better over time.

8053.03 -> Even if difficult eventually makes doing better reflexive.

8056.93 -> If you're enjoying this podcast and learning from it,

8059.61 -> please subscribe to our YouTube channel.

8061.41 -> That's Huberman Lab on YouTube.

8063.54 -> And there, you can also leave us comments and feedback

8066.23 -> and suggestions for future topics and future guests

8069.86 -> for the Huberman Lab Podcast.

8071.83 -> As well we hope that you will subscribe

8073.65 -> on both Apple and Spotify and on Apple,

8075.91 -> you have the opportunity to leave us up to a five star

8078.54 -> review and to give us feedback there as well.

8081.88 -> Please also check out the sponsors mentioned

8083.55 -> at the beginning of the podcast,

8084.81 -> that's a terrific way to support the podcast.

8087.24 -> And if you'd like to support research on stress,

8089.67 -> human performance, sleep and so forth,

8092.26 -> you can go to a hubermanlab.stanford.edu.

8095.55 -> And there there's a tab that you can click.

8097.86 -> If you'd like to make a tax deductible donation

8100.418 -> to the laboratory,

8101.67 -> to explore the sorts of things that relate

8103.64 -> to neurocircuits stress, sleep and human performance.

8106.97 -> Not today, but oftentimes on this podcast,

8109.37 -> we discuss various compounds and supplements

8111.55 -> that people could possibly take in order to help deal

8116.01 -> with anxiety, improve gut microbiome,

8118.48 -> improve their sleep, et cetera.

8120.46 -> We didn't discuss those today,

8121.54 -> but for those of you interested in those compounds,

8123.31 -> if you want to see the ones that I take,

8125.18 -> you can go to Thorne that's T-H-O-R-N-E

8128.887 -> .com/the letter U/huberman.

8133.546 -> So, it's thorne.com/u/huberman.

8135.94 -> See all the supplements that I take,

8137.34 -> you get 20% off any of those supplements.

8139.6 -> And if you enter the Thorne site through that portal,

8142.414 -> you can get 20% off any of the supplements that Thorne makes

8145.09 -> we partnered with Thorne

8147.422 -> because they have the highest levels

8148.255 -> of stringency with respect to the quality of ingredients,

8151.33 -> the precision of the amounts of those ingredients.

8153.74 -> And while supplements are certainly not required

8155.77 -> or necessary for anything really,

8158.34 -> you can always use behavioral tools.

8159.66 -> Many people benefit from taking supplements

8161.3 -> of various kinds.

8162.2 -> And we do believe that getting supplements

8164 -> of the very highest quality is going to be important

8166.14 -> if that's the decision for you.

8168.49 -> And last but not least,

8170.09 -> I want to thank you for your time and attention.

8172.51 -> And thank you for your interest in science.

8174.062 -> [fast-paced music]

Source: https://www.youtube.com/watch?v=2XGREPnlI8U