Episode 36: Healthy Eating & Eating Disorders – Anorexia, Bulimia, Binging | Huberman Lab

Key Takeaways

  • Food and eating are highly individualized – no one can tell you exactly when and what you should be eating in a single protocol because we just don’t have the biomarkers
  • Since we can’t truly define healthy eating, it’s important to understand unhealthy eating and unhealthy relationships with food
  • Anorexia, bulimia, and binge eating are all distortions in relationship to food where reward and habit are disrupted beyond control
  • Anorexia overrides all homeostatic processes driving people towards food and weight sustaining nourishment
  • Anorexia has a biological underpinning: anorexics feel good by approaching foods that are low fat, low calorie and are rewarded more than if eating in a healthier way to support the weight
  • Creating awareness about what the habits are and train brain switch about what should be rewarding (not starving) and shutting down reward (starving) is the key treatment in anorexia
  • Anorexia is more habit-based while binge eating and bulimia cause food to be hyper attractive (like driving a car with no breaks)
  • Bulimia and binge eating are marked by hyper impulsivity and lack of top-down processing (if this then that thinking) and inhibitory control
  • While pharmaceuticals are not helpful for the treatment of anorexia, drugs that increase serotonin are beneficial for bulimia and binge eating in combination with cognitive behavioral therapy

Introduction

Dr. Andrew Huberman, Ph.D. is a Professor of Neurobiology and Ophthalmology at Stanford University School of Medicine. His lab focuses on neural regeneration, neuroplasticity, and brain states such as stress, focus, fear, and optimal performance.

In this episode of Huberman Lab, Dr. Huberman discusses what drives hunger and satiety and the role of our brain, stomach, fat, and hormones in regulating hunger. He takes a deep dive into disordered eating and healthy relationships with food.

Host: Andrew Huberman (@hubermanlab)

Intermittent Fasting & Optimizing Muscle Growth

  • Many people find it easier to not eat than regulate what they eat
  • Intermittent fasting: restricting eating to a particular phase of the 24-hour cycle (e.g., eating window 4 or 8 hours)
  • Water fasting: not eating for entire days – consuming water only or water with salt
  • It’s important to consume electrolytes or put a little salt in the water if fasting because neurons of the brain and body are dependent on adequate levels of sodium, potassium, magnesium
  • Findings don’t suggest any differences in insulin sensitivity and liver enzymes based on the time of the feeding window
  • Protein synthesis is greater early in the day versus late in the day
  • Ingesting protein and amino acids early in the day (between 5 am-10 am) may be beneficial to muscle growth and hypertrophy
  • Regardless of whether you are vegan, vegetarian, etc. – leucine is a critical amino acid

Regulation of Hunger, Feeding, Satiety

  • When the stomach is full it sends signals to the brain that are purely mechanical – not based on the nutritional profile of food
  • Neurons trigger eating (AgRP neuron) and cessation of eating (POMC)
  • Appetite is lower in summer months than winter months
  • Body fat and information from the gut signal the brain about different levels of nutrients and hunger
  • The more body fat we have, the more leptin released to suppress appetite
  • Leptin signaling is disrupted in people with obesity or bulimia
  • Gut sends signals about amino acids, proteins, sugars
  • From a purely evolutionarily perspective, it makes sense that we want to eat as often as we can, as much as we can, and as fast as we can because food was survival

Anorexia

  • Relationships to food are highly individualized
  • Definition of anorexia: ingesting fewer calories than burned
  • Traits of anorexia: loss of muscle mass, low blood pressure, low heart rate, hair growth on the face, loss of bone density, loss of menstruation, disrupted gut and immune symptoms, high cholesterol, hyper-focus on details within the environment, distortion of appearance versus reality
  • Anorexia is the most dangerous psychiatric disorder with the highest prevalence of death
  • Anorexia is a disruption of reward processes: anorexics have a reflexive hyper-awareness about the fat content of food and default towards low calorie, low-fat foods subconsciously and are rewarded by avoiding higher fat, higher-calorie foods that sustain weight
  • Anorexia typically starts in adolescence when youth find food aversive
  • Males do suffer from anorexia, but women struggle with anorexia about 10x more frequently 
  • Rates of anorexia in the past 10-20 years are not increasing – and have actually stayed similar as compared when they were first documented in the 1600s
  • Myths: eating disorders and disordered eating is a desire to be perfect and look like people in ads, anorexia is a disease of the rich and well off (points to biological disruption)

Treatment Of Anorexia

  • Anorexia can be difficult to study because it’s more about the absence of a behavior than a behavior
  • Habits and behaviors of people with eating disorders are prime places for intervention
  • Teach the individual what is leading up to their habit of selecting food and associate interactions with foods to different reactions in the body (e.g., elevated heart rate, anxiety, etc.)
  • Family-supported models have been successful in establishing greater understanding and proper support around mealtime, food to keep on hand
  • Cognitive-behavioral therapies are often used in conjunction with other treatments
  • 50% of individuals will relapse
  • Psychedelics: MDMA and psilocybin clinical trials are ongoing for the treatment of eating disorders
  • Use resistance training to build muscle and train the mind to see food as a way of nourishing the exercise

Bulimia & Binge Eating Disorder

  • Definition of bulimia: binge eating or overeating then purging
  • Definition of binge eating: overeating, usually in sittings (but without the purging)
  • Many people with binge eating disorders are gravely obese – the signal to eat is there but the signal to stop eating is not
  • Traits of eating: ingesting 10-30x daily caloric intake within two hour period, unable to control eating and override signals
  • Frequency of binging: by definition, at least 1-2 times per month over a period of several months and usually increasing in frequency
  • Consequences of bulimia: disruption to the mucosal lining of the digestive tract, severe disruption to the microbiome, laceration of the esophagus, shame, social isolation because it’s hard to hide vomiting  
  • Lack of inhibitory control and hyper impulsivity separates bulimic from anorexic
  • Bulimia is prevalent in both sexes and appears to be on the rise

Treatment Of Bulimia & Binge Eating

  • Pharmaceutical treatments for bulimia and binge eating increase serotonin to allow for more top-down control to push the brain into processing and anticipating outcomes
  • Deep brain stimulation is experimentally being used to treat binge eating disorder to offset the elevated sense of reward from binge eating
  • Behavioral interventions coupled with drug-based interventions are better than either alone
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Notes By Maryann

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