TEDx Transcript: Dr. Laura Hill on Eating Disorders from the Inside Out

Laura Hill at TEDxColumbus

Dr. Laura Hill, CEO of The Center for Balanced Living discusses Eating Disorders from the Inside Out at TEDxColumbus. The following is the transcript of the TEDx Talk.

Dr. Laura Hill – CEO, The Center for Balanced Living

Food is as fundamental — the most fundamental source of energy. It is the source of energy for us to have our strength in daily living, and it is the centerpiece around which we establish a sense of joy, communication, celebration. It’s the way we socialize. We socialize around food.

But then, what about those who might have a reaction to food? And then, there are those, for example, with type 1 diabetes. With type 1 diabetes, a person cannot eat sugar in the same way as those who don’t. The pancreas literally breaks down, and cannot accompany the sugar into the cells, and so the body starves.

So, when you think of diabetes, how do you think of diabetes: as a social illness, say, psychological illness or a biological illness? How many would say biological? That’s the way the majority of us think of it, because we know that’s the predominant cause of the illness.

But when you think of eating disorders, do you think of eating disorders as a social, psychological, or biological illness? It’s that eating disorders may be psychological and social as well, but there is a serious biological basis to this illness, and it’s a brain basis. Instead of the pancreas breaking down, what we are now knowing is that there are pathways in the brain that are not functioning in the same way as those who don’t have an eating disorder.

I’m going to focus today on anorexia and what we know from the inside out. And what I want you to know from all the areas of eating disorders, there are about 10 million persons in the United States with anorexia and bulimia, according to the National Eating Disorders Association, and millions more with binge eating disorder and other variations of those disorders.

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We know that eating disorders have the highest death rate of all mental illnesses. So, it’s not something that we can just think lightly about. And it’s very difficult to treat.

So, let’s just start with you. Let’s just start with the sense that hopefully, all of you had breakfast this morning. And, with that breakfast, you got some energy to start and enjoy this day, here at TEDx. So, a person without an eating disorder enjoys their toast, has a little more jam, feels pleasure from what they’re eating and enjoys the taste and gets on with it. And on you go.

But a person with an eating disorder, such as anorexia, when they eat, they experience high anxiety, extreme thought disturbance, and noise. I want to give you an idea of what that noise sounds like. [Chattering voices] And so the person who has an eating disorder and has had her breakfast, she’s now trying to go to work, she’s trying to go to class. And the noise and the disturbance is acute. She’s trying to hear her professor through the noise. She’s trying to hear her employer talk to her, and have an interaction with her. And she’s trying to focus, through the noise.

So, how in the world, if she’s going to have a breakfast, and then she’s supposed to have lunch, and she’s supposed to have dinner too, and the noise continues to be acute, “How can I function, how can I work, how can I have a decent interaction, and a clear focused interaction, and get this project done? How? Simply by not eating. Because if I don’t eat, Dr Hill, I can then think more clearly. If I don’t eat, Dr Hill, please just don’t have me eat breakfast, then I can get this assignment done. And then I’ll go ahead and eat something, so then I can go ahead and get something, because you say you’re needing it, but don’t ask me to take that test and eat breakfast too, because, if I do, I have to take the test and think through the noise. I have to finish the assignment and think through the noise.

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So, what do we do to be able to help a person with anorexia, whose mental noise is so disturbed, yet, they need food? So, let’s explore what’s going on in the inside of the brain, so that we can better understand what that looks like.

As we are looking at this research, we are seeing how the brain fires, through fMRI studies. Now, those are 3D studies, and it’s not just looking at a picture. The “f “means “functional”. So, they would give the patient a task, while they’re watching what goes on in the brain and watching the oxygen blood flow.

So, when you’re eating, and it comes up from the gut and the signals get into the brain, the signal moves through the thalamus right into the insula. And the insula is the part of your brain that gives the indication of hunger or fullness, “I think I’m a little hungry; I better have some breakfast.” “Ah, that toast, that tasted good.” The taste and the degree of hunger comes out of the insula.

Right next to the insula is your amygdala, and that’s your alarm system that says, “Anything wrong with the toast? Okay, then I’ll stay calm, I’ll be quiet.” “Anything wrong with…? Nope, I’m just alright.” So, amygdala just stays quiet.

And then it moves to the bottom of the striatum, and you’re going into the pleasure circuit. And the pleasure circuit, that dopamine, goes to a little high angle. “Woo! That was nice; I’ll have another, hmm, yes!” And so, whenever you make a decision and you get pleasure from it, you have a little dopamine spike. “So, shall I put jam on it?” I taste it, “Hmm, that was good, I’ll have some more.” So you get these little pleasure surges in the dopamine. It’s your brains way, gut sensation, that says, “Yeah, yum!”

And so, then, the front of the brain begins to start interpreting it: “Well, if you liked it, and the amygdala is not showing any alarm, let’s move it forward and let’s have some more.” And then the cortex starts weighing “Is this good/bad?” And so, “Oh, it tasted good, I liked the toast. I’m hungry, then I’ll go ahead and eat it”, says the ACC.

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And then on we go to the dorsolateral prefrontal cortex, which is where Carly Simon sings about anticipation. Only I’m thinking about anticipation with food, not other areas. So, when we look at anticipation for the next bite, “Oh, I think I could have another one. That’s fine, I’ll have another bite.”

And parietal then takes in, a sense of the brain that looks at, “How am I in relation to those around me?” So, “Oh, I look okay.” So then, you have another bite. “Hmm, that was good” All right, then have some more. I’ll have another bite, I still look okay. Take a third bite. So, as you’re eating your toast with your jam, and you’re looking around, you’re saying, “Isn’t this good? Why can’t she just eat? Why can’t she just enjoy her food? Look, I’ll fix this for you, I know you’ll like it, It’s really good.”

Now, for the person with anorexia. Same brain, same stations. So, we’ve got the insula, but, when that person takes the bite of the toast, with anorexia, we actually get no signal. None. It’s so flat, there’s no signal for hunger in the insula. There’s no system or signal for the sense that the hunger is getting a little worse. So, while their body is starving, and it’s sending signals up, the insula is not getting it. It’s just letting that serotonin pass right on by, and the serotonin is not registering.

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