Dr. Casey Halpern: Biology & Treatments for Compulsive Eating & Behaviors | Huberman Lab Podcast #91

Andrew Huberman・2 minutes read

Dr. Casey Halpern's work in deep brain stimulation targets neurological and psychiatric diseases like OCD, focusing on treating compulsions through brain circuit modification. The laboratory's application of engineered devices to stimulate specific brain areas offers promising solutions for conditions like loss of control eating and binge eating disorder.

Insights

  • Dr. Casey Halpern's laboratory focuses on using engineered devices for direct brain stimulation to address compulsions causing overeating, showcasing innovative approaches to treating neurological disorders.
  • Deep brain stimulation targeting the nucleus accumbens shows promise in controlling loss of control eating, highlighting the role of brain regions like the nucleus accumbens in managing compulsive behaviors.
  • OCD involves dysfunction in cortical control areas like the orbital frontal cortex and prefrontal cortex, impacting inhibitory control, emphasizing the complexity of brain circuitry in psychiatric disorders.
  • Non-invasive brain stimulation methods like transcranial magnetic stimulation and ultrasound are explored for treating conditions like depression and OCD, highlighting the importance of collaboration between specialists to enhance treatment precision.
  • Patients struggling with binge eating often have awareness of their problem but struggle to control their behavior, even with various treatments, underscoring the challenges in addressing compulsive behaviors through traditional therapies.

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Recent questions

  • What is the focus of the Huberman Lab podcast?

    The Huberman Lab podcast delves into science and science-based tools for everyday life, hosted by Andrew Huberman, a professor at Stanford School of Medicine. The podcast aims to provide free science-related information to the public, covering a wide range of topics related to health, performance, and neuroscience advancements.

  • How does deep brain stimulation help in treating neurological disorders?

    Deep brain stimulation involves the use of engineered devices to stimulate neurons in the brain directly, targeting specific brain areas with electrical current to alleviate conditions like movement disorders, essential tremor, and Parkinson's disease. This innovative approach represents the forefront of brain circuit modification for treating neurological and psychiatric diseases, offering insights into cutting-edge neuroscience advancements.

  • What is the role of the nucleus accumbens in controlling eating behaviors?

    The nucleus accumbens, a brain region responsible for releasing dopamine for motivated behaviors, is targeted to manage loss of control eating in conditions like binge eating disorder and obesity. By modulating this brain region through deep brain stimulation, researchers aim to control urges for risky rewards like overeating or drug use, potentially preventing harm to individuals struggling with compulsive behaviors.

  • How are eating disorders like binge eating and anorexia being studied?

    Studies on eating disorders like binge eating and anorexia involve exploring the dysfunction in brain regions like the nucleus accumbens, which are associated with reward processing and compulsive behaviors towards food. Deep brain stimulation trials targeting these brain areas show promise in blocking behaviors linked to loss of control eating, with ongoing research focusing on episodic stimulation approaches for effective treatment.

  • What are some non-invasive methods being explored for treating psychiatric conditions?

    Non-invasive brain stimulation methods like transcranial magnetic stimulation (TMS) and ultrasound are being investigated for treating conditions such as depression, OCD, addiction, and obesity. Collaboration between neurosurgeons and non-invasive specialists is crucial to enhance the precision and effectiveness of these techniques, offering potential alternatives to invasive procedures for managing psychiatric diseases.

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Summary

00:00

Innovative Neurosurgery for Eating Disorders and More

  • The Huberman Lab podcast discusses science and science-based tools for everyday life, hosted by Andrew Huberman, a professor at Stanford School of Medicine.
  • Dr. Casey Halpern, Chief of Neurosurgery at the University of Pennsylvania School of Medicine, focuses on bulimia, binge eating disorder, and obsessive-compulsive behaviors.
  • Halpern's laboratory emphasizes the development and application of engineered devices to stimulate neurons in the brain directly to address compulsions causing overeating.
  • The laboratory's approach involves brain surgery, including removing or stimulating small brain areas with electrical current or through the intact skull to alleviate eating disorders.
  • A recent study by Halpern's team in Nature Medicine explores deep brain stimulation in the nucleus accumbens to control loss of control eating.
  • The nucleus accumbens, a brain region releasing dopamine for motivated behaviors, is targeted to manage loss of control eating.
  • Halpern's work represents the forefront of brain circuit modification for treating neurological and psychiatric diseases, including movement disorders like essential tremor and Parkinson's disease.
  • Deep brain stimulation and other approaches are discussed for treating movement disorders during the podcast, offering insights into neuroscience advancements.
  • The podcast aims to provide free science-related information to the public, with sponsors like Roca, Eight Sleep, Inside Tracker, and Momentous offering products related to health and performance.
  • Dr. Halpern's specialization in deep brain stimulation highlights the precision and innovation in neurosurgery, focusing on therapeutic electrical stimulation in specific brain regions for various conditions.

14:23

Innovative Treatments for OCD and Beyond

  • Deep brain stimulation can cause temporary side effects like laughter or panic, which can be therapeutic for conditions beyond movement disorders.
  • Stimulation of brain areas involved in emotion, not just motor circuits, can lead to improvements in mood and compulsive behaviors.
  • Immediate relief of tremors can be achieved through deep brain stimulation, inspiring advancements in therapeutic treatments.
  • OCD can manifest in various ways, from obsessions to compulsions, and can be challenging to treat effectively.
  • SSRI and tricyclic medications are commonly used for OCD, along with exposure response prevention therapy.
  • Deep brain stimulation and capsulotomy are surgical options for severe OCD cases, with varying levels of effectiveness and risks.
  • OCD involves dysfunction in cortical control areas like the orbital frontal cortex and prefrontal cortex, impacting inhibitory control.
  • The frontal lobe, particularly the orbital frontal cortex and prefrontal cortex, along with the basal ganglia, play crucial roles in OCD.
  • The ventral striatum, including the nucleus accumbens, is involved in reward-seeking behavior and compulsions, potentially contributing to OCD symptoms.
  • Research is ongoing to better understand the brain areas involved in OCD and develop more targeted and effective treatments for the disorder.

29:39

"Risks, Urges, and Rewards in Society"

  • Taking risks is essential for success in society, such as in patient care where judgment calls are made.
  • OCD is a condition where consistent judgment puts individuals at risk, often manifesting in hyper checking or contamination behaviors.
  • Patients with eating disorders exhibit behaviors like overeating or purging despite risks.
  • Addiction leads individuals to seek drugs despite risks, showcasing a common urge despite potential harm.
  • Athletic Greens, now AG-1, is a comprehensive nutritional drink covering essential needs like probiotics for gut health.
  • Caffeine and stimulants can trigger compulsive behaviors, like superstitions, which may fade when stimulant use stops.
  • Vulnerability to stimulants can be linked to predispositions like OCD tendencies, impacting brain function and behavior.
  • The nucleus accumbens is a crucial part of the brain's reward circuit, influencing urges for rewards and risk assessment.
  • Urges for risky rewards, like overeating or drug use, may need treatment to prevent harm to oneself or others.
  • Deep brain stimulation trials are exploring modulating the nucleus accumbens in patients with obesity and binge eating disorder post-gastric bypass surgery.

44:04

"Understanding Binge Eating and Obesity Links"

  • Tom Wadden, former director of the Obesity Center at Penn, highlighted that not all individuals with obesity exhibit addictive tendencies towards food, with only about 20% showing such behaviors.
  • Loss of control eating, common in both eating disorders and obesity, is linked to a dysfunction in the nucleus accumbens, a region associated with reward processing.
  • Exposure to high-fat food in mice led to altered functioning in the nucleus accumbens, potentially predisposing to continued behavior and habit formation.
  • Invasive trials aim to restore normal functioning in the nucleus accumbens, with deep brain stimulation showing promise in blocking behaviors associated with loss of control.
  • Patients with binge eating disorder may experience loss of control eating multiple times a week, with severe cases involving daily binging episodes.
  • Binging disorder is characterized by consuming a large amount of food in a brief period, leading to a sense of loss of control.
  • Anxiety and reduced prefrontal activity can both contribute to binge eating, indicating a complex dysregulation of brain circuitry.
  • Binge eating disorder is prevalent, affecting 3-5% of the population, potentially under-diagnosed in individuals with obesity.
  • The availability of highly palatable and cheap foods in modern society may contribute to the development of binge eating tendencies.
  • A two-hit hypothesis suggests a predisposition to binge eating, exacerbated by environmental factors like the abundance of sugary and fatty foods.

58:45

"Craving cells and disrupting binge-eating cycles"

  • Evolutionary advantage of avoiding certain foods that cause sickness
  • Predisposition to vulnerable foods in a food-focused society
  • Stressful events as a second hit in developing eating disorders
  • Embarrassment faced by patients due to societal stigmas on obesity and anorexia
  • Research on nucleus accumbens involvement in reward-seeking behavior
  • Use of electrode placement in the operating room to detect and block cravings
  • Identification of craving cells through patient exposure to food images
  • Real-time monitoring of single neurons in the nucleus accumbens during craving
  • Feasibility study guidelines for identifying craving cells safely and efficiently
  • Strategy of triggering stimulation to disrupt craving and binge-eating cycles by briefly elevating mood

01:13:46

"Optimizing Brain Stimulation for Mental Health"

  • Patients in clinics may initially feel great after device stimulation, but the effects often diminish over time, leading to a return of symptoms like depression or OCD.
  • Continuous stimulation in mice showed a decrease in the effectiveness of blocking binge eating, suggesting intermittent stimulation may be more robust and durable.
  • Episodic stimulation is recommended over continuous deep brain stimulation for certain conditions, while continuous therapy may be more suitable for state disorders.
  • In the operating room, the goal is to identify craving cells, deliver safe stimulation, capture elevated mood moments, and conduct an intraoperative CAT scan for accuracy confirmation.
  • Connectomics is used for brain imaging to map out circuit connections, targeting areas like the nucleus accumbens and prefrontal cortex for stimulation.
  • Success in surgery is measured by achieving two out of three goals: identifying craving cells, delivering safe stimulation, and capturing elevated mood moments.
  • Anorexia and binge eating disorder are seen as related conditions, both driven by compulsions towards food despite risks, suggesting similarities in brain vulnerabilities.
  • Studies on deep brain stimulation targeting the nucleus accumbens for anorexia have shown benefits, with ongoing research focusing on episodic stimulation approaches.
  • Non-invasive brain stimulation methods like transcranial magnetic stimulation and ultrasound are being explored for treating conditions like depression and OCD.
  • Collaboration between neurosurgeons and non-invasive specialists is crucial to enhance the precision and effectiveness of non-invasive brain stimulation techniques.

01:28:43

"Ultrasound Targeting Brain Disorders: Future Potential"

  • TMS Target for anorexia and obesity is a potential future development
  • Eating disorders and TMS have been minimally studied
  • Non-invasive approaches are critical due to patient conditions
  • Ultrasound historically allowed brain probing with more freedom
  • Patients preferred midline thalamic structure stimulation evoking frustration and anger
  • Ultrasound is FDA-approved for Tremor treatment
  • Ultrasound can open the blood-brain barrier for targeted medication delivery
  • Essential Tremor is more common than Parkinson's
  • FDA-approved ultrasound for Tremor is effective and non-invasive
  • Ultrasound could be explored for psychiatric diseases like OCD, depression, addiction, and obesity

01:43:43

Struggles with binge eating and brain stimulation

  • Patients struggling with binge eating often have awareness of their problem but struggle to control their behavior despite various treatments like cognitive behavioral therapy and medications.
  • Invasive brain surgical trials are being conducted on these patients, but even with experimental treatments, they still can't stop themselves from binging.
  • Patients are brought to the laboratory with implanted devices to detect craving signals before stimulation is initiated.
  • Mood provocation techniques are used to induce binge-related moods in patients for video synchronization with brain signal recordings.
  • Eye trackers are worn by patients to monitor their eating habits and what they are looking at before binging.
  • Patients, even under video surveillance, still engage in binging behavior despite being aware they are being studied.
  • Cognitive behavioral therapy aims to improve patient awareness of their problem, but its limitations include the need for continued therapy to prevent relapse.
  • Machines and artificial intelligence are being explored to anticipate impulsive behaviors like suicide by analyzing voice patterns and physiological cues.
  • Neurosurgeons are cautious about activities that could risk their hands, like heavy grip exercises, to protect their livelihood and motor skills.
  • Despite potential risks, supervised strength training like deadlifts can improve posture and physical health, but caution is advised for those in specialized professions.

01:58:30

Neurosurgeons prioritize fitness and balance in life.

  • Engaging in jogging, cycling, and swimming is recommended for overall health.
  • Incorporating resistance training with six hard sets per muscle group per week is crucial for muscle maintenance, skeletal function, and tendon strength.
  • Neurosurgeons also prioritize resistance training with proper form to maintain physical health.
  • Neurosurgeons are noted for their calm demeanor, essential in their high-stakes profession.
  • The precision required in neurosurgery necessitates a calm and controlled approach to avoid errors.
  • Neurosurgeons may learn techniques to calm their body and mind, such as redirecting energy to stabilize their hands during procedures.
  • Neurosurgeons may use meditative practices to prepare for challenging surgeries or after stressful situations.
  • Neurosurgeons are known for their confidence, which stems from rigorous training and experience.
  • The demanding nature of neurosurgery attracts individuals with specific personality traits, such as calmness and efficiency.
  • Neurosurgeons often develop strategies to maintain quality time with family and friends despite their demanding schedules.

02:12:17

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