How to Manage "Stress Eating" & Compulsive Eating | Dr. Elissa Epel & Dr. Andrew Huberman
00:00:00.000 | What is the relationship between stress and eating and eating and the opioid system?
00:00:09.600 | Stress and eating is an interesting one.
00:00:11.600 | So most people when they feel stressed or, you know, I'm just going to ask you, do you
00:00:16.600 | eat more or less when you're stressed?
00:00:18.840 | Less, definitely.
00:00:20.200 | I feel like I can go two, three days without food when I'm really stressed.
00:00:24.940 | But I came up in a profession where sadly for me, all-nighters were part of the regular
00:00:31.640 | until pretty recently, a couple of years ago when I just called an end to that.
00:00:37.160 | And no, it wasn't just because of procrastination, it was just work overload.
00:00:41.080 | But I can go a long period of time without eating, although I love to eat.
00:00:45.800 | So I do point out that I do love to eat.
00:00:47.720 | And what does the body feel like when you're in that stress state, when you're not even
00:00:50.760 | hungry, you're kind of shut down in your digestion?
00:00:54.280 | That I have enough energy from my neural resources, from adrenaline.
00:00:58.800 | And generally, those periods of time when I'm not hungry coincide with a hyper focus
00:01:04.800 | on the stressor, the deadline, whatever it is in life that needs tending to.
00:01:11.280 | And food just doesn't appeal to me as much.
00:01:14.560 | It doesn't taste as good and it's not as enticing.
00:01:17.200 | Yeah.
00:01:18.200 | So we think that your type of body temperament is high sympathetic.
00:01:24.040 | And so when you have a big stress response, your digestion is pretty much shut down.
00:01:29.400 | It would be the opposite.
00:01:31.200 | Eating would be the opposite of what your body's telling you to do.
00:01:33.720 | I'm just going to, forgive me for interrupting.
00:01:35.960 | For those of you hearing sympathetic, we're not talking about sympathy.
00:01:39.280 | We're talking about the sympathetic arm of the autonomic nervous system, which is the
00:01:42.840 | so-called fight or flight arm, as opposed to the parasympathetic.
00:01:45.840 | In any event, sorry to interrupt, but wanted to make sure that sometimes people hear sympathy
00:01:50.040 | and then they think emotional sympathy.
00:01:52.300 | I like to think I have that too.
00:01:53.840 | But okay.
00:01:54.840 | So I tend to lean more towards the sympathetic, meaning more alertness arousal on the seesaw
00:02:02.560 | of the autonomic nervous system.
00:02:04.200 | And I'm a high sympathetic reactor.
00:02:06.960 | I lose weight when I go through, like writing my dissertation, I looked like a skeleton
00:02:10.940 | at the end.
00:02:12.380 | But that's not what most people complain about.
00:02:14.740 | It's not weight loss.
00:02:15.740 | Most people complain about overeating or binge eating when they're emotional, when they're
00:02:19.960 | stressed.
00:02:20.960 | And that's the more common pattern.
00:02:23.160 | And what that, that looks different, both in the brain and biologically.
00:02:28.860 | And so what it looks like is that the stress response is driving cravings.
00:02:37.480 | And also, let's say high insulin or an insulin resistant state.
00:02:41.800 | And what goes along with that is tending to be overweight or have obesity.
00:02:46.340 | And so just by whether it's through conditioning or genetics, having that kind of larger body
00:02:53.080 | with a big stress eating temperament, that is a challenge in life.
00:02:57.840 | And I've been, you know, I've worked with people with different eating conditions, eating
00:03:01.800 | disorders, binge eating.
00:03:03.560 | And it is a, what's hard about it is number one, it's very common and normative to just
00:03:10.840 | feel like you can't feel satiated.
00:03:15.120 | So it's this compulsive eating tendency that stress brings you to.
00:03:19.220 | And so the, so what it means, we measure this, it's very easy to measure, it means that people
00:03:24.740 | feel like they can't control their eating, they don't get full, they think about food
00:03:31.800 | a lot.
00:03:33.060 | And so stress kind of exacerbates that tendency.
00:03:35.940 | And that is a, you know, it's a common phenotype.
00:03:38.780 | Like we've studied it and maybe 50% of people with obesity have that.
00:03:42.940 | Do lean people have that?
00:03:44.900 | Some, not many, like less than 20%.
00:03:47.740 | But what they also have is this tremendous kind of diet, what we call dietary strain
00:03:52.320 | or control over their eating.
00:03:53.660 | So they're, they are able to, to not overeat, even though they're thinking about food a
00:04:00.000 | lot.
00:04:01.240 | So that's, that is, you know, that explains that unusual body of someone who's really
00:04:08.040 | more has still has those compulsive traits.
00:04:11.400 | So why does this matter?
00:04:13.780 | Stress makes it really hard to eat well, because when you're stressed, you're craving the comfort
00:04:19.580 | food, the high fat, high sugar, high salt, depending on your temperament.
00:04:24.980 | And that is, that means with repeated bouts of stress, you're just going to be gaining
00:04:30.460 | weight and particularly in the intra-abdominal area.
00:04:33.500 | That's what we've seen.
00:04:34.500 | We've seen it cross-sectionally, we've seen it in rat studies, and mice studies, and now
00:04:38.340 | we've seen it in people and many, for about 10 years I studied this.
00:04:42.100 | And the question was, is what's happening in people the same thing that's happening
00:04:45.560 | in mice?
00:04:46.560 | If you stress them out and you give them Oreos, the mice develop binge eating, they get really
00:04:51.500 | compulsive and they get this, you know, terrible metabolic health profile, metabolic syndrome,
00:04:56.900 | where their, their round, you know, their, their belly fat basically expands like a cushion.
00:05:03.060 | And that's because that's this really good immediate source of energy during stress.
00:05:06.680 | So like, we're really well wired to, if our body thinks we're under chronic stress, we're
00:05:11.060 | going to store stress fat or abdominal fat, so we can just mobilize that in a second.
00:05:16.420 | And then the second question we've asked is, can you reverse that with different interventions?
00:05:21.540 | Can you, can you block the compulsive eating?
00:05:24.420 | So I can, I can tell you what we found there.
00:05:27.260 | But the opioid system that you mentioned is certainly involved.
00:05:30.780 | And in studies with people, lean people and people with obesity, my colleague, Rajita
00:05:37.420 | Sinhat-Yale, it's basically found that when you stress them out, people with obesity are
00:05:42.860 | having a different reward response.
00:05:47.020 | And they're having, they're, the more insulin resistant they are, the more their reward
00:05:51.180 | center lights up during stress.
00:05:53.700 | And what's causal there?
00:05:55.940 | Like what's the chicken?
00:05:56.940 | What's the egg?
00:05:57.940 | So, because I can imagine these were people that at one time were not obese, who got stressed.
00:06:04.540 | The opioid system reacted in a particularly potent way to food and they were able to clamp
00:06:12.820 | their stress.
00:06:13.820 | And so then they become binge eaters in the context of stress.
00:06:18.940 | And that leads to insulin insensitivity.
00:06:22.340 | I could also imagine that they were insulin insensitive, therefore they need to eat more
00:06:26.300 | in order to feel kind of an increase in satiety, as we know this now, based on brain and body
00:06:35.420 | mechanisms.
00:06:36.420 | And then that set off a cascade of things leading to obesity.
00:06:40.820 | Not that it necessarily matters, but what's causal?
00:06:44.340 | Do we know if it's--
00:06:45.340 | Oh, I think it really does matter.
00:06:46.340 | I think there's been a mistake of kind of confounding all obesity with food addiction
00:06:54.260 | and metabolic disease, and it's completely heterogeneous.
00:06:56.820 | So I think it's the developmental path that you're describing, which is that there's a
00:07:01.820 | tendency toward having a bigger reward response and hunger during stress.
00:07:08.320 | So it becomes a way of coping, a lifestyle, and that is a pathway toward obesity.
00:07:14.100 | And so some obese people have a dysregulated stress response, but not all of them.
00:07:20.540 | I mean, it really is a certain type of person.
00:07:23.380 | So that's why we target people with cravings in all of our intervention studies now.
00:07:28.540 | We want to know who has more of the compulsive eating type, because they need a different
00:07:34.900 | set of skills to cope with stress and to lose weight, if that's their goal.
00:07:41.340 | There's a drug, I'm sure you're familiar with, naltrexone, which can block the opioid receptor.
00:07:46.140 | It's used to block the opioid receptor in the context of different types of addiction.
00:07:50.340 | Have people tried to use naltrexone in the context of binge eating, and does it help
00:07:54.140 | people lose weight?
00:07:55.500 | Because it presumably reduces some of the rewarding properties of food?
00:08:01.620 | That's one of the very few drug combinations that has been used for binge eating.
00:08:05.820 | So it was a combination of naltrexone and Welbutrin.
00:08:09.200 | And I'm not sure at this moment how much that's favored for binge eating, but certainly the
00:08:14.020 | early trials showed that it really does damp down on the compulsive eating.
00:08:17.860 | Interesting.
00:08:18.860 | There's a commonly prescribed kit of drugs now for obesity.
00:08:23.500 | I know there's a lot of excitement nowadays about these semaglutide analogs, because they
00:08:29.420 | do seem very effective in blocking hunger, especially in type 2 diabetics.
00:08:32.780 | I don't know if you're familiar, but there's all the rage, mostly because people saw the
00:08:36.940 | before and after photos of Elon, he had a shirt off on a boat and there were some not
00:08:41.300 | so nice comments made about him, and then sometime later he was quite a bit lighter
00:08:45.100 | and he announced that he'd been taking one of these semaglutide agonists.
00:08:50.700 | I really hope that we come up with safe and effective drugs.
00:08:55.780 | And one thing to think about is that the challenge that we all have, particularly if we're prone
00:09:02.700 | to obesity, is the toxic food environment, and particularly the refined sugar.
00:09:07.100 | And regardless of what we're on, metformin or one of these drugs, we override it with
00:09:11.920 | our diet.
00:09:12.920 | And really, the improved nutrition is the only way to solve it as a public health problem.
00:09:17.740 | I mean, the drug companies are saying everyone should be, everyone with a certain BMI should
00:09:21.620 | be on one of these new drugs, and it's just rubbish, and it's not going to lead to long-term
00:09:25.860 | health.
00:09:26.860 | Well, I know you have a colleague there at UCSF, Dr. Robert Lustig, who's been talking
00:09:32.340 | about sugars and hidden sugars for years and the problems with that.
00:09:36.580 | And we don't want to demonize sugar as the only cause of the obesity epidemic, but it's
00:09:41.500 | certainly one of them.
00:09:42.500 | At least that's my belief, according to the data.
00:09:44.900 | Yes.
00:09:45.900 | And Rob is the biggest proponent of helping people understand the big problem and the
00:09:51.580 | root is in the processed food and the sugar, and that the drugs don't touch that.
00:09:57.380 | We override effects of any drugs with our diet.
00:10:01.220 | And so it's been a losing battle, really, because of the force of big food and big pharma.
00:10:12.940 | So let me go back to the compulsive eating.
00:10:15.260 | So there are some clues about how to break that cycle.
00:10:19.180 | So one is in our weight loss trials or our healthy, mindful eating trials, we find that
00:10:27.780 | mindful eating is not going to cause a lot of weight loss, period.
00:10:30.980 | And if the people who benefit most from learning this kind of calm self-regulation where you
00:10:36.260 | check in with your hunger, you slow down, you increase your awareness of your body,
00:10:42.540 | so interoceptive awareness, that type of skill is really critical for people with compulsive
00:10:51.740 | eating.
00:10:52.740 | And so in our trials, we find that people with compulsive eating, if they get randomized
00:10:57.740 | to the mindful eating, they do better in terms of their insulin resistance and their glucose
00:11:03.060 | and their long-term weight loss.
00:11:04.980 | So that's one good clue.
00:11:06.700 | Another is the positive stress pathway looks important for breaking the compulsive eating
00:11:12.220 | cycle.
00:11:13.220 | So high-intensity interval training or maybe some of these other ways that we've been talking
00:11:20.060 | about to increase the bodily stress in these short-term ways to metabolize stress in our
00:11:24.900 | body can help with the cravings.
00:11:27.980 | So what would that look like in the context of – let's say somebody has the opposite
00:11:32.020 | phenotype to me.
00:11:33.020 | They get stressed and they find themselves reaching for snack food or that they simply
00:11:36.560 | can't reach satiety.
00:11:38.020 | They just want to eat and eat and eat.
00:11:40.380 | What are some of the – aside from naltrexone and wellbutrin and some of these prescription
00:11:44.100 | approaches, because I always say while I value – certainly value prescription drugs in
00:11:49.620 | certain contexts, I always feel like behavior should come first, do's and don'ts, then
00:11:54.740 | nutrition, then supplementation, and then if and only if it's still needed, prescription
00:11:59.300 | drugs.
00:12:00.300 | But that's just my bias based on my observations.
00:12:01.700 | Pretty reasonable.
00:12:02.700 | I like to think so.
00:12:04.460 | It also is a – it starts at a zero-cost endeavor.
00:12:08.820 | I mean behaviors require time, but it certainly includes everybody, not just those that have
00:12:14.820 | insurance or that live in a particular region of the U.S. or the world.
00:12:18.340 | So anyway, that's my bias and at least for the time being, I'm sticking with it.
00:12:23.140 | It's the basis of a lot of what we talk about on this podcast.
00:12:25.820 | But nonetheless, if somebody is finding themselves in that category of binge eating or heading
00:12:33.000 | towards binge eating or using food to comfort or alleviate stress, how should they intervene
00:12:39.680 | in their own thoughts and behavior?
00:12:42.540 | We talked about the bins, top-down strategies, changing the body, changing the scene.
00:12:47.540 | We need all of those.
00:12:48.540 | I mean the compulsive drive to eat is one of our strongest impulses if we've developed
00:12:55.100 | that pathway.
00:12:56.100 | And so we train people, for example, in mindful awareness of separating out emotions from
00:13:03.980 | hunger.
00:13:04.980 | So they get really wrapped up together.
00:13:06.300 | So just labeling how you're feeling, labeling your hunger from one to ten, and figuring
00:13:11.140 | out am I really hungry or is it boredom.
00:13:14.300 | That helps people.
00:13:15.300 | And if you do that check-in right before you eat, that helps the most.
00:13:18.740 | So that's the top-down mindful check-in.
00:13:21.420 | The other thing we help people do is like ride the craving, surf the urge.
00:13:29.020 | So we deal a lot with soda drinkers and it is addictive and there is nothing worse than
00:13:36.300 | drinking sugar soda for our body.
00:13:38.680 | So we help people by having them watch their craving pass and knowing that it's a matter
00:13:47.700 | of time that they can surf the urge without jumping to consuming.
00:13:52.420 | And so that practice helps some people, especially with practice.
00:13:56.460 | The push-ups, the taking a walk, the changing the scene, getting away from food is always
00:14:02.540 | going to be a huge strong strategy if you can get yourself away from it.
00:14:07.340 | The problem is, as you know, is that the cravings get you to the buffet.
00:14:11.020 | They drive you to the soda, etc.
00:14:14.540 | And so just creating safe environments both at home and in the workplace where you don't
00:14:19.060 | have soda is really important.
00:14:20.820 | So we tried that at UCSF.
00:14:22.820 | My colleagues and I, including Rob Lustig, the anti-sugar doctor, we just saw the absurdity
00:14:29.860 | of being a medical center.
00:14:32.380 | People come with these chronic diseases and what are they served in a cafeteria or even
00:14:37.300 | at their bedside?
00:14:39.420 | Sugared Coke.
00:14:40.420 | In the hospital.
00:14:41.420 | In the hospital.
00:14:42.420 | And so my colleague, Laura Schmidt, who's partly responsible for the soda tax, she rallied
00:14:49.260 | all the – we went top down to administration but bottom up to vendors, got rid of all the
00:14:55.460 | soda in all of our hospitals and campuses.
00:14:58.340 | And we found two things.
00:14:59.640 | Number one, people who were heavy drinkers lost weight in the most important place, their
00:15:07.600 | waist.
00:15:08.600 | Heavy soda drinkers?
00:15:09.600 | Mm-hmm.
00:15:10.600 | So when we took it out of the workplace, they actually – their health improved.
00:15:15.200 | And number two, those with compulsive eating, they score high on our little scale for reward
00:15:23.040 | based drive.
00:15:25.400 | It didn't help them.
00:15:27.160 | So then we randomized half of them to get some extra boost.
00:15:31.600 | We call it motivational interviewing where we're really supporting them more and helping
00:15:35.180 | them think of goals like being with their grandchildren, not getting diabetes, and that
00:15:41.000 | little bit of support helped them tremendously.
00:15:44.800 | And so now we're trying to roll that out in a big controlled trial.
00:15:49.600 | But at least 100 hospitals have adopted the stop selling sugary drinks because people
00:15:56.440 | don't want to be sick but they can't help it if they have the reward drive and if they
00:16:00.720 | have the compulsivity and it's right there at work.
00:16:03.240 | We're just working against health.
00:16:05.880 | [Music]