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🎧 Eating Disorders | Huberman Labs

🎧 Eating Disorders | Huberman Labs
By Elizabeth Filips • Issue #8 • View online
Heya, I try to listen to quite a few podcasts, so I thought I would summarise them in this newsletter, just in case you don’t have time/energy to listen to them yourself, or if you’d like some information on a topic you wouldn’t be inclined to sit through a whole podcast for.
I will be putting an earphone emoji at the front of the newsletters for podcasts (🎧), so if you really don’t fancy reading these ones and want to just stick to the books, you can always skip them!
Eating disorders are a topic quite close to my heart, so I honestly could have screamed out of joy when I saw that Huberman Labs had made a full two hour podcast on them. Here is what stood out to me:
The number of people that die from eating disorders is the same as those that die from automobile accidents.
Any discussion around food is very difficult, especially at a time where in the modern world, when we do eat, most of the time it is out of desire rather than out of need. Where do we then draw the lines between fun and pain, intermittent fasting and disordered eating, cheat days and binges.
General points about food consumption:
  1. Ingesting Amino acids earlier in the day leads to more muscle hypertrophy in humans compared to later in the day → so if you are interested in muscle growth, you might want to ingest your protein earlier in the day
  2. BMAL genes are what vary in expression throughout the day which create cellular circadian rhythms for cells
  3. Melanocytes suppress appetite - which is why we’re less hungry (and lose weight) in the summer
  4. You don’t need 20 mins to know that you’re eating (the general advice we get about how we can only feel full after 20 minutes is a myth) - you don’t need to wait for that for satiety. But you should probably chew more anyways
  5. Evolutionarily: we should eat as often, as much, as fast as we can - eating food was always scarce, dangerous and competitive
  6. Knowledge of knowledge can allow you to make better decisions (so if you know that you have faulty wiring, you can change it)
General points about eating disorders:
  1. They are a disruption in the homeostatic and reward pathways such that decision making is disrupted and in many cases not available to the anorexic or bulimic
  2. The issue is that there is a mismatch between what we “should do” and our “behaviour”, knowing where this is and what motivates it can help us intervene
  3. Genes don’t control behaviour, they bias probabilities for behaviour
Anorexia:
  1. The proportion of the population with anorexia nervosa has remained constant for the last 400 years (this greatly weakens the argument that social media has had a significant effect on anorexia BUT the data is less clear in the case of bulimia, and body dysmorphia) → furthermore, anorexia is not just a disease of the rich or of cases where food is abundant, it is prevalent in all societies to an equal extent almost (SHOCKING to me)
  2. Anorexia has the highest mortality rate out of any mental health condition, depression included
  3. People will know that their behaviour can lead to death, but they cannot intervene (they don’t want to eat that food, they cannot help it)
  4. Anorexics have a great evaluation centre for food in the brain (how much calories it has, how much fat it has), but their habits are disrupted → they are often not aware that they are making such dangerous decisions for their own health
  5. You’d think just solving the anxiety around food would solve anorexia, but it doesn’t → serotonin doesn’t help, both because it increases satiety, and also because simple anxiety around food is not the issue → they have a hyper-acuity around the fat content of food
  6. From a young age, anorexics are learning so much information about the macronutrient content of food, to the point that avoiding high calorie foods becomes a reflex
  7. They then develop a brain circuitry that is wired to reward them for picking low calorie foods and avoiding normal foods, so they do not the get the same reward for eating as they should
  8. Habits are perpetuating the reward for low calorie and punishment for eating → so you need to see what is the thing that is leading to the habit
  9. Habit formation is the best place to intervene with anorexia
  10. They need to be taught to notice what happens in their body when being exposed to different foods, and be aware of them; hyperventilation, high BP or pulse
  11. Knowledge of knowledge can allow you to make better decisions (so if you know that you have faulty wiring, you can change it)
  12. Anorexics do often have body dysmorphia → they literally have a faulty perception of what they look like, in experiments where they are to create/pick out avatars with their body shape, we can see that they do not perceive their own body shape in a way that someone without an eating disorder would do
  13. Therefore, simply “you’re so thin, you should eat” doesn’t help, because they don’t see themselves that way
  14. It’s very hard to change visual perception in the brain, it’s much easier to rewire habits around eating. But there is evidence that eventually, with healthier eating habits, the visual perception in the brain of the body does improve too
  15. Weak central coherence is where you cannot see the forest from the trees - for example, once you are given a random image, how long does it take you to pick out a face placed in some position in the image, then after you’ve seen the face, you can’t go back to losing it
  16. Hyper-acuity on a particular feature, you miss the bigger picture → this is what can happen with anorexics, but in the same way, it is the first step to improvement:
  17. Once you teach anorexics what is happening to them, and what they are doing, they are able to break away from it
  18. Family support is very important in eating disorders: not making them feel worse, not triggering them, shaming them, but helping support them (in CBT) in combination with habit recognition and rewiring approach (especially when done early in life) → but lack of family support in individuals who do not have it, or who do live alone, does make recovery harder
  19. Very high relapse, about 50% usually around difficult life circumstances
Bulimia
  1. Can be described (in colloquial language) as cheat days that they cannot control - 10-30x amount of daily calories within 2h for example, sometimes multiple times a day, multiple times a week or month, followed by purges (self-induced vomiting, laxatives, excessive exercise)
  2. In bulimia there is no stopping with fullness, the brain is overriding all signalling for fullness
  3. Thyroid hormones have been shown to be elevated or depleted in different stages of the binge purge
  4. Sexual trauma is not necessary for the bulimic, unlike what was thought in the past
  5. Bulimics show hyper-impulsive behaviour; for example, when they have one impulse gone wrong, then they binge (can be drinking a bit or succumbing to another impulse)
  6. Prozac and other ADD medication do actually help with bulimia; prefrontal cortex is under active, less impulse control naturally which can be helped with this medication
  7. There is embarrassment of not being able to control behaviour as an adult
  8. Where the anorexic feels as though they’re winning a game by avoiding food = the reward pathway is in the behaviour, with the bulimic the reward is before the behaviour, making food feel better than it is, so there is no break, no impulse control
Binge eating
  1. This is eating incredible amounts of food (like with bulimic) but without the follow-up with a purge
  2. Has been treated with deep brain stimulation for the nucleus accumbens, related to dopamine control and reward pathways
  3. Creates a perception in the individual that food is hyper-rewarding

The episode, show notes, and links to studies mentioned:
Did you enjoy this issue?
Elizabeth Filips

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