Huberman Lab

Biology & Treatments for Compulsive Eating & Behaviors | Dr. Casey Halpern

My guest is Casey Halpern, M.D., Chief of Stereotactic and Functional Neurosurgery and Professor of Neurosurgery at the Perelman School of Medicine at the University of Pennsylvania. Dr. Halpern’s research and clinical practice focus on using deep brain stimulation to treat compulsive and movement disorders—for example, binge eating disorder, bulimia, obsessive-compulsive disorder (OCD), Parkinson’s disease, essential tremor and dystonia. We discuss using deep brain stimulation to help patients who suffer from movement and compulsive disorders and its application to patients afflicted with binge eating. We also explore the use of this technology for other conditions such as OCD, anorexia and tremor, and examine future therapeutic directions involving non-invasive brain stimulation approaches, including transcranial magnetic stimulation and ultrasound, for the treatment of other psychiatric illnesses and conditions. This episode will interest those curious about the biology of eating, anorexia, bulimia, compulsive thoughts and behaviors and movement. Thank you to our sponsors AG1 (Athletic Greens): https://athleticgreens.com/huberman ROKA: https://www.roka.com/huberman Eight Sleep: https://www.eightsleep.com/huberman InsideTracker: https://www.insidetracker.com/huberman Supplements from Momentous https://www.livemomentous.com/huberman Social & Website Instagram: https://www.instagram.com/hubermanlab Twitter: https://twitter.com/hubermanlab Facebook: https://www.facebook.com/hubermanlab TikTok: https://www.tiktok.com/@hubermanlab LinkedIn: https://www.linkedin.com/in/andrew-huberman Website: https://hubermanlab.com Newsletter: https://hubermanlab.com/neural-network Dr. Casey Halpern Penn Medicine Profile: https://www.pennmedicine.org/providers/profile/casey-halpern Twitter: https://twitter.com/halpernc LinkedIn: https://www.linkedin.com/in/casey-halpern-a1569749 Responsive Neurostimulation For Loss Of Control Eating (DBSLOC) Study: https://www.clinicaltrials.gov/ct2/show/NCT03868670 Articles Pilot study of responsive nucleus accumbens deep brain stimulation for loss-of-control eating: https://go.nature.com/3Sc1ZA1 Timestamps 00:00:00 Dr. Casey Halpern & Disordered Eating & Brain Stimulation 00:03:18 ROKA, Eight Sleep, InsideTracker 00:07:19 Momentous Supplements 00:08:28 Neurosurgeon’s View of the Brain, Neurosurgery Specialization 00:13:05 Deep Brain Stimulation & Other Unexpected Positive Effects 00:17:20 Obsessive Compulsive Disorder (OCD), Prescriptions & Cognitive Therapies 00:25:40 Brain Areas in OCD, Risk, Rewards & Addiction 00:31:11 AG1 (Athletic Greens) 00:32:27 Facial and Vocal Ticks, Stimulants, Stress & Superstition 00:39:28 Nucleus Accumbens, Reward Circuits, Eating Disorders & Obesity 00:47:18 Stimulation of Nucleus Accumbens, Continuous vs. Episodic Stimulation 00:49:49 Binge Eating Disorder & Loss of Control Eating 00:53:02 Developing Binge Eating Disorder: Predisposition, Environment, Stress 01:02:07 Electrodes in Nucleus Accumbens, Identifying “Craving Cells” 01:11:41 Effects of Stimulation, Interrupting Craving, Intermediate Stimulation 01:16:46 Anorexia, Obesity & Compulsions, Potential Treatments for Anorexia 01:23:14 Non-Invasive Brain Stimulation, Transcranial Magnetic Stimulation 01:32:27 MRI-Guided Focused Ultrasound: Tremor, Essential Tremor & Parkinson’s 01:36:40 Future of Non-Invasive Brain Stimulation, Epilepsy & Depression 01:41:51 Pre-Behavioral States in Compulsion & Awareness, Mood Provocation 01:48:02 Machine Learning/Artificial Intelligence & Compulsion Predictions 01:53:05 Neurosurgeon Hands, Resistance Training & Deadlifts 01:59:00 “Neurosurgeon Calm,” Quality Time & Prioritization, Neurosurgeon Training 02:09:53 Daily Habits: Sleep, Exercise, Mediation 02:11:59 Zero-Cost Support, YouTube Feedback, Spotify & Apple Reviews, Sponsors, Momentous Supplements, Neural Network Newsletter, Instagram, Twitter, Facebook, LinkedIn The Huberman Lab Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

AHAndrew HubermanhostCHCasey Halpernguest

Sep 26, 2022·2h 14m·Watch on YouTube ↗

📖 CHAPTERS

1. 1
   0:00 – 7:00

   Intro to Episode and Guest: Brain Circuits for Compulsive Eating

   Huberman introduces Dr. Casey Halpern, a neurosurgeon whose lab focuses on bulimia, binge eating disorder, and obsessive-compulsive behaviors. He frames the discussion as a look at cutting-edge neuromodulation—especially deep brain stimulation—for both eating and movement disorders.

2. 2
   7:00 – 18:40

   What Neurosurgeons Do: Structure vs. Circuit Modulation

   Halpern explains the broad scope of neurosurgery, from tumors and aneurysms to spine and nerve disorders. He contrasts structural surgeries with functional procedures like DBS and focused ultrasound that directly alter brain activity to treat symptoms.

3. 3
   18:40 – 35:40

   Immediate Effects of Brain Stimulation: From Tremor Relief to Emotion

   Responding to Huberman’s question about 'outrageous' brain effects, Halpern describes transient laughter, panic, or mood changes when stimulating near certain regions. He emphasizes how observing side effects led to new uses for DBS beyond movement disorders.

4. 4
   35:40 – 47:40

   Defining OCD and Its Treatment Landscape

   Halpern outlines how OCD ranges from helpful traits to debilitating disorder and reviews medications and behavioral therapies. He notes that about 30% of patients remain severely affected despite treatment and are the ones considered for DBS or lesion procedures.

5. 5
   47:40 – 58:20

   OCD Circuits: Frontal Cortex, Basal Ganglia, and Ventral Striatum

   The discussion shifts to the brain regions implicated in OCD and compulsive behavior. Halpern describes dysregulated frontal cortical areas and their projections to dorsal and ventral striatum, including the nucleus accumbens, as central to gating urges versus risks.

6. 6
   58:20 – 1:11:40

   Personal Anecdotes: Tics, Stimulants, and Superstitions

   Huberman shares his childhood throat-clearing tic and a college episode where stimulants precipitated a transient 'knock-on-wood' superstition. Halpern uses these to illustrate how vulnerable brains can be to environmental and pharmacologic hits.

7. 7
   1:11:40 – 1:22:40

   Nucleus Accumbens: From Rodent Reward Hub to Human Target

   The conversation centers on the nucleus accumbens as a hub for reward, motivation, and compulsion. Halpern describes rodent studies showing how high-fat diets rapidly alter accumbens function and set the stage for loss-of-control behaviors.

8. 8
   1:22:40 – 1:38:40

   Binge Eating Disorder, Loss-of-Control Eating, and Obesity

   Halpern clarifies definitions of binge eating versus loss-of-control eating and how they relate to obesity. He describes his NIH-funded DBS trial for patients with severe binge eating who failed gastric bypass, aiming to restore control via accumbens modulation.

9. 9
   1:38:40 – 1:56:40

   Designing Human DBS Trials: Finding 'Craving Cells' in Surgery

   Halpern explains how intraoperative recordings are used to locate craving-related neuronal activity in the nucleus accumbens. Patients are shown personalized high-craving food images in the OR while single neurons and local field potentials are recorded.

10. 10
    1:56:40 – 2:15:20

    Responsive Stimulation: Blocking Craving → Binge Transitions

    The focus shifts to responsive, closed-loop DBS that triggers only when pathological activity appears. Halpern outlines how craving is operationalized, why brief positive mood induction might interrupt binge chains, and what mouse data suggest about timing.

11. 11
    2:15:20 – 2:38:00

    Anorexia, Shared Circuits, and Future DBS Directions

    Halpern argues that anorexia and certain forms of obesity are more similar than they appear, both involving compulsive eating-related behaviors despite risk. He reviews preliminary DBS work for anorexia and his plans to adapt responsive approaches.

12. 12
    2:38:00 – 2:54:00

    Noninvasive Neuromodulation: TMS, Focused Ultrasound, and Limits

    They discuss the current clinical status of TMS and MR-guided focused ultrasound. Halpern supports integrating neurosurgical insight into noninvasive methods but insists that circuit-level knowledge from invasive work is essential to make them precise.

13. 13
    2:54:00 – 3:07:00

    Using Epilepsy Techniques to Map Psychiatric Circuits

    Halpern describes how stereo-EEG—multiple depth electrodes used in epilepsy workups—is being repurposed to study depression and OCD circuits. This approach could eventually inform both DBS and noninvasive treatments.

14. 14
    3:07:00 – 3:27:00

    Awareness, Behavior Therapy, and the Limits of Willpower

    Huberman and Halpern explore the role of self-awareness in preventing binges or compulsive acts. Halpern values awareness and CBT-style strategies but explains why, in the most severe cases, awareness is present yet insufficient.

15. 15
    3:27:00

    Neurosurgeon Mindset: Training, Stress, and Personal Tools

    The final segment turns to neurosurgeons’ characteristic calm and how they cope with intense training and responsibility. Halpern shares his own struggles with stress, weight gain during residency, and the physical and mental tools he now uses.