The Healing Brain: How Understanding the Neuroscience of Eating Disorders Enhances

Treatment Compliance

Eating Disorder Conference-Omaha, NBSept. 28, 2019- 10:15-11:15

Ralph E Carson RD, CED-RD, PhD

Nutritionist and Exercise Physiologist

Eating Recovery Center

Senior Clinical & Research Advisor

Intelligence ↔ Creativity• “Knowledge is limited;

imagination is unlimited” (Einstein)

• The problem for scientists is when it tries to explain things that can’t be observed

Scientific Method

Complementary and Alternative

Medicine

Here are the facts

Here are the conclusions

What conclusions can we draw from

them?

What facts can we find to support it?

Bringing Neuroscience into the Therapy Session

• It matters for therapist to understand and help their patients

• It matters to the patient to make sense of her experience of difficulty eating, drive to move, and body image.

Neuroscience Accelerates and Improves Recovery(Guisinger ’03; Kardum ‘08)

PsychoeducationKnowing facts better equipped to succeed

Brain imaging brings neuroscience to wider

population

More stay with the program

Interested in researchReality: Genetics;Neuroscience &

Health Consequences

Construct a neuralmap of the cause

Feel more control over their disorder

Places them withincomfort zone

Triggers and perpetuating factors

Uncover biomarkersthat predict occurrence

Knowing facts better equipped to succeed

Non-threatening way to deal with disease

Readiness to changeIdentify indicators for recovery and relapse

warnings

Greater likelihood of permanent recovery

Therapist: Neuroscience

More Effective as a Therapist

Confidence in Efficacy of Therapeutic Knowledge and Technique

Able to Fill in Knowledge Gaps

Rethink Current Approach

Assessment; Feedback; Outcomes

We Judge Science by whether or not it agrees with what we believe

• Placebo: • Believe in the act of being treated

• Believe in effectiveness

• Nacebo• Believe we will get sick

• Allergy (Vlieg-Boerstra ‘07)

• Results is what matters; and not how we got there

The Contribution of Neuroscience to Recovery(Zakzanis ’10; Lauer ’99; Chiu ‘08)

• Construct a Picture

• Instills confidence In the treatment

• Belief increase the likelihood of successful outcomes

• Clients highly value their cognitive functioning, and can find this motivating

Brain Damage?

Damage: Loss of Cell Volume(McCormick ‘06)

Dial up and High Speed InternetDrawing inferences is speculative

Brain complexity & the emergence of neuroscience

• No evidence that people are predominately R or L brain

• Speech processing was thought to occur in the Wernicke's & Broca's area of the left brain (Nielsen ‘13)

• Speech involves the use of both sides of the brain (Cogan ‘14)

• No area works in isolation

• The brain functions in circuits

Phineus Gage (1823-1860)1848, Vermont

• Cutting a railroad bed

• 3 ½ feet x 1 ¼ “ tamping iron

• Tapping explosives into a hole and then detonated

• Left eye and prefrontal lobe

• Profanity; indifference to others; impulsive and poor decision making and planning

PET SCAN fMRI SCAN

SPECT SCANEEG

DTI SCAN

VBM SCAN

High Definition Fiber

Tractography

Functional

Connectivity MRI

Inherited(Predisposing)

Triggers(Biopsychosocial)

(Precipitating & Perpetuating)

Neuro Alterations

RepairTherapy

Changes the way you think

Nutrition Sleep

Genetics Environment Cell LossNeuro-

regenerationCBT

COHFiber

Sleep Hygiene

Traits DietingAlteration of

PathwaysNeuroplasticity ERP Ω-3 FA

Circadian Rhythm

Shift

HPF; Inactivity

Depletion Neurotransmitters

Collateral DBTFruits and

VegCPAP

StigmaDownregulation

receptorsResilience ACT Protein

Stress(Cortisol)

EpigeneticsExtinction or

RefilingEMDR

VitaminsMinerals

Biology is not destiny

NEUROGENESIS

Left Prefrontal Cortex Right Prefrontal Cortex

Prefrontal Cortex

Happiness Anger Fear

Disgust

Neuroplasticity

• Axonal guidance

• Dendritic arborization

• Synaptogenesis

• Receptors

• Neurotransmitters

• Growth Factors

Rubber Hand Illusion(Botvinick ’98; Ehrsson ’05b)

• Brushed spontaneously while looking at rubber hand

• Gain ownershipRubber → Real

• Perception can be rewired

Collateral Repair(Reicht ’11; Cohen ‘04)

Resilience: Adapting in the face of Adversity(Southwick ’12; Graham ’13; Davidson ’13; Botvinick ‘01; Amodio ’07; Husseini ‘01)

• Flexibility to change when the old ways no longer work

• Practice increases the number and strength of connections in the resilience circuit

• Amygdala• mPfC; vmPfC; lPfC; dlPfC• NAc; ventral striatum• ACC

• Elevation of dopamine and BDNF

Evolutionary Instinct: Advantage for coping with famine(Guisinger ’03; Kersting ’04; Sheurink ’10; Illius ‘2002; Casper ’06)

• Food Scarce: Hungry, weak and fatigued

• Triggers an archaic adaptation

• Starvation Induced hyperactivity (SIH)• Decrease food

• Increase activity

• Overachiever: Difficult foraging journey

• Food Plentiful: Restored to reproductive capabilities by clan

Starvation activated genes(Geisinger ’03; Ammar ‘00; Baird ‘06; Bartness ‘11; Beaumont ‘96; Cabanac ’89; Leklin ‘02, ‘03; Keen-Rhinehart

‘07, ‘08; Negardh ’07; Rutten ‘13; Stewart-Knox ’12; Presnell ‘07; Franklin ‘06) )

• NPY1: Stimulates feeding

• SIH unmasks NPY2: Foraging and hoarding

• Facilitates activity

• AgRP: Feeding → Foraging (Dietrich ‘15)

• Repetitive and ritualistic behavior

Dutch Starvation Winter 1944 (Ammar ‘00; Baird ‘06; Bartness ‘11; Beaumont ‘96; Cabanac ’89; Leklin ‘02, ‘03; Keen-Rhinehart ‘07, ‘08; Negardh ’07;

Rutten ‘13; Stewart-Knox ’12; Presnell ‘07; Franklin ‘06)

• Considerable distances & great physical expense foraging for food

• NPY2 facilitated activity needed for foraging

• NPY2 inhibits consumption and directs attention to food acquisition

Temperament Anorexia References

Novelty Seeking Low Cassin ’05; Fassino ’02; Karwautz ’02

Harm Avoidance High Cassin ’05; Fassino ‘02, ’04; Klump ’04; Atiye ‘15

Reward Dependence Low Klump ’04; *Atiye ‘15

Persistence HighCassin ’05; Diaz Marsa ’00; Fassino ’02b; ’04; Atiye

’15; Bulik ’99; Karwautz ‘02

Self-Directedness LowCassin ’05; Diaz Marsa ’00; Fassino ’04; Klump ’04;

Bulik ’99; Karwautz ’02; Fassino ‘02; ‘04

Cooperativeness Low Cassin ’05; Klump ’04; Karwautz ’02;**Bennett ‘04

Self-transcendence HighCloninger ’94; Pham-Scottez ’12; Bulik ’99;

Karwautz ‘02

Temperament: Relevance(Ely ’15; Clonigner‘86; ’93, Fassino ‘02; Liu ’79; ’07; Klump ’04; Roberts ’04; Tchanturia ‘07; Lopez ‘04; Lask ‘05)

Thalamus: D2 Receptor Deficiency

• Relay station: Filters what gets through; Sensory - Thalamo -Cortical

• ↓Thalamic D2BP (D2 binding potential)

• ↓ Filtering• ↑ Cortical excitement• ↑ Creativity

• Reduced in (Santosa ‘07)

• Addiction• BED; LOC• ADHD

Creativity: How does it come about?

• Ideas come in a disorganized way

• Link up ideas in novel ways

Persistence: The Tale of Two Frogs“It is not that I am so smart; it is that I stay with problems

longer” Einstein

Are Introverts smarter?

• Outperform extroverts • Academically in High School and

College• IQ wise they are similar

• Receive a disproportionate number of graduate degrees

• Deep thinkers• Possess Analytical skills that integrate

and process complex concepts• Creative?... Persistent• Better in handling information

overload

Set Shifting: Sensory - Thalamo – Cortical(Santosa ’07; Gilbert ‘00; Kim ’01; Saxena ’08; Rachman ’09; Harsanyi ‘07)

• ↑ Thalamic D2 binding potential

• ↑ Filtering

• ↓ Cortical excitement and new associations

• ↓ Set shifting

Resistance to change

Cognitive Flexibility

Habit Change

Hebb’s Law: Nerves that Wire Together, Fire

Together

Quantum Zeno Effect:Long Term Potentiation

Mindfulness(Kabat-Zinn)

Body Dysmorphia: Integration Exteroceptive & Interoceptive(Guardia ‘12)

Take 2” off Your “Waist”Attractive: Eye Contact an invitation to enter one’s space

LOC: Hedonic Neurocircuits

• Insula: Sensory overload (Wang ‘01; ’09)

• VAT: β-Endorphins &μ – receptors (Gosnell ’09; Bernard

’03; Bello ‘09a)

• NAc: Reward receptor deficiency (Berthoud ‘11; Wang ‘01;

’09; Blum ‘96;’00)

• vmPfC & dlPfC: Free won’t (Carr ‘11; Volkow ’12; Weygandt ‘13)

LOC

Stress: Serotonin(O'Connor ‘08; Singh ‘07; Streigel-Moore ’07; Hagan ‘02; Heatherton ’91; Pike ’06;

Steigel -Moore ’07, Teegarden ‘07)

High Fat Food is Self-Soothing(van Oudenhove ’11)

• Nasogastric tube

• Brain scan

• Melancholy tunes

• Saline: No Change

• Fatty acids• Reduced sad feelings

• Reduced hunger by half

Satisfied? (Janowitz ’50; Wolf ‘47)

Dissociation Capsule(van der Kolk ‘15)

• Traumatic event is encapsulated in the cortex

• Retrieval is challenging

• Overly consolidated memory

• Therapy: Shrink and extinguish dissociation capsule

Cues or Thoughts

Present Moment

Amygdala Kindling(Scaer ‘07)

• Flashbacks, intrusive thoughts, nightmares: Float in time and invade & corrupt present moment

• Amygdala: Smoke detector

• Intrusive thoughts from repressed memories keep the amygdala kindling (idling)(Scaer‘07)

Heightened immune reactivity ↑ likelihood of developing PTSD(Posh ’07; Tal ’13; Hendricksen ’14; Dobbs ’09; Lilienfeld ’12; Glatt ’13; Velasquez-Manoff ’15; Eraly ’13)

• Chronic stress revs up neuronal immune function

• ↑CRP prior to developing PTSD (Glatt ’13; Eraly ’14)

• WBC secrete cytokines cross BBB → inflammation

• Glial cells are sensitive to inflammation

• Alters neuroplasticity and synaptogenesis

Prefrontal Cortex: Executive Function (Watchtower)

• Dimmer switch for Amygdala• Regulates emotions in response

to fear

• Inflammation causes PfC goes off line with amygdala

• Lose access to higher cognitive function

Trauma, Chronic Unresolved Stress, Worry(Rainnie ’09; Scaer ’01, ’05; Van der Kolk ’85; Chen ’10; Muchu ‘11)

• Fear & anxiety: Flood the brain with cortisol

• Cortisol is neurotoxic

• Triggers inflammation

• Stress Damages the Brain and Alters Repair (Kim ‘02)

• Shut down healing & regeneration

• Decreased BDNF• Alters neuroregeneration

380 cc vs. 1500 cc

60% of the Brain’s Dry Weight

Membrane Fluidity

• Lots of unsaturated

bonds

Substituting Omega 6, Trans or Saturated Fats Impairs Docking

Neurobiology of Binge Eating Disorder – A Synopsis

• https://psychscenehub.com/psychinsights/neurobiology-of-binge-eating-disorder/

• www.drcrysstalcollier.com• Crystal@drcrystalcollier.com

• 713-254-9719

• The neuro WhereAbouts Guide