Now I’m learning about hypothalamusing

Lots of people, including HAES subscribers, believe human beings have a set point or range where their weight will always be.  It takes great effort to get your weight above or below your set point, although repeated attempts can probably raise it.  If there is a set point, one likely candidate for its controller is the hypothalamus.  It comes up enough that it seems worth my time to find out what the hypothalamus is.

The hypothalamus is part of the brain.*  It translates the electrical impulses in your brain into signals to endocrine glands to produce and release hormones, which signal the rest of your organs to do their thing.  In this way, the brain is like general.  It dictates orders to its secretary, the hypothalamus.  The secretary than copies all the orders and sends them to the relevant lieutenant generals (glands), who respond by releasing the appropriate hormones.  For example, it coordinates the ebb and flow of melatonin (produced by the pineal gland) and cortisol (produced primarily by the adrenal glands), so that you can wake up in the morning and fall asleep at night.  It also translates from hormones to the brain, turning “I’m hungry” into cooking, or “I’m horny” into hitting on someone.

What does this have to do with food and weight?  If I had a definitive answer to that I would be rich (and better nourished).  Damaging specific parts of the hypothalamus while keeping environment constant causes weight change in rats that previously maintained a stable weight.  Damaging other parts causes the rat’s weight to be more affected by an environment (i.e. before damage they previously maintained a particular weight regardless of what food was offered.  After damage they lost weight when food was unpalatable and gained weight when it was more palatable).  And we’ve tracked several hormones that communicate status between the hypothalamus, adipose tissue, and digestive organs, in ways too complicated to fit into this overview post.

In summary, the hypothalamus is the connection point between the brain and your hormones, and no one really knows what either one is saying.

*One thing that always bugs me when I hear the phrase “part of the brain” is  “how sharp is the distinction between this part and other parts?  Can there be cells where it’s a matter of judgement which section they fall into?  Can you just look at an arbitrary brain and say “there, that’s the hypothalamus”?”  I eventually found this video, which very explicitly detailed how each part of the brain is separated, except for the hypothalamus, which he just sort of gestured around.  As we’ll read later, scientists are able to precisely destroy sub sections of of the hypothalamus so I guess its boundaries are pretty sharp.

Ghrelin: The Hunger and Lung Development Games

Writing about hormones is hard because anything I say will be incomplete by necessity.  I can only do so much research,  and will undoubtedly miss something.  More worryingly, there’s a lot nobody knows about our endocrine system, and all available overviews tend to overstate our level of certainty.  I will be ecstatic if in 10 years this entry turns out to be 60% true.  But we go to war with the facts we have, so:

Ghrelin is best known as… well if you’re me it’s “proof calories in/calories out is bullshit“, but it’s more commonly known as “the hunger hormone”.  The simple story is that cells in your stomach produce ghrelin in response to perceived space in the stomach (which may be one way gastic bypass surgery leads to decrease in food consumption: your stomach reports fullness almost immediately).  Your hypothalamus detects this and informs the brain, which interprets it as hunger, which should lead you to get food.

But nothing in the human body does just one thing.  For one, ghrelin is produced in other areas of the body.  Pancreas, intestines (sure, they have information about current digestion status), placenta (okay, the fetus needs a way to direct you to eat more), gonads, adrenal cortex, pituitary gland (well those are pretty general hormone production factories), kidneys (for…water…consumption?), and lungs (the hell)?

Ghrelin encourages storage of calories as fat, which could mean that eating more (to suppress ghrelin production)  would help you avoid fat gain or even allow fat loss.  But (one form of) ghrelin also triggers production of human growth hormone (in fact, that’s where the name comes from: Growth Hormone RELease INducing factor), which encourages burning fat and building muscle.  The important lesson here is that if someone every tells you “Do X lose weight because hormone Y does Z”, you should laugh at them, even if Y and Z are correct, because Y does 4 million other things, some of which are the opposite of Z.  Ghrelin’s presence in the lungs might be a mechanism to trigger HGH to trigger fetal lung development.  Or maybe not.  We don’t know.

Still in the realm of possibility, high ghrelin levels delay puberty and discourages ovulation.   This is a reasonable second job for the hunger hormone to have because transforming a zygote into a baby is an epic amount of work and you want to be well fed.   I seriously wonder about the effects on ghrelin on libido: given that humans have sex for both reproduction and social bonding,** I could see the effect going either way.

Ghrelin appears to have some mood effects.  When I first read this I assumed high ghrelin -> stress and depression, which would be a convenient way of explaining why I was so jumpy before my hypochlorhydria was treated.  Turns out, nope, ghrelin is an anti-depressant* , which may be one mechanism reinforcing anorexia.  But ghrelin also makes pleasant activities (eating, but also drugs, and it’s at least in the same brain neighborhood as sex) more rewarding.  It also has a bunch of effects on learning and memory and stress-based learning, mostly apparently positive.  This is the opposite of what I would have predicted, given how I and people I know act when hungry.

I'm sorry for what I said when I was hungry

Lastly, ghrelin inhibits inflammation. To the point it may be useful as a treatment for autoimmune diseases like rheumatoid arthritis and multiple sclerosis.   This concerns and confuses me, possibly even more than growth hormone effects. Hunger and long term calorie deficits are associated with increased susceptibility to disease (as your body prioritizes short term goals over long term health), so maybe this is a happy accident?  But no, ghrelin promotes development of at least one kind of white blood cell.  The anti-inflammatory effect may explain why people often don’t want to eat while injured- your body lowers ghrelin levels to allow healing to occur, and the loss of appetite is a side effect.  But that’s highly speculative, the truth is we just don’t know.

For all that, ghrelin is one of the simplest hormones I’ve studied.  It has one obvious primary job, and several of its lessen effects seem at least related to that job.  We know where it is produced and a good chunk of how it achieves its (known) effects.  More fundamental hormones like progesterone, testosterone, or oxytocin are infinitely more complicated.  So this post is a little bit about the science of hunger, and a lot about how the human body is complicated and people with simple answers are liars.

*Should you be laughing at me right now?  Maybe.  The study in question shows actual behavior change, not a potential mechanism of behavior change (that’s this paper), but it is just one study.  Perhaps compromise on chuckling.

**What about pleasure, you ask?  Irrelevant from an evolutionary standpoint.  We feel pleasure because there is some actual useful purpose served.

Damnit

1.5 years ago I did a food sensitivity test, and it came back “yes”.  I gave up wheat, eggs, and milk.  After 4 weeks my chronic heartburn was gone and I generally felt better.  Not better enough to stick with it indefinitely- at the beginning of 2014 I fell off the wagon due to a combination of stress and changes in my access to food.  The problem with sensitivities is that it’s a very delayed feedback mechanism.  One bite of foods I am sensitive too doesn’t bother me at all, in the moment or later.  Conversely, giving up all those (delicious) foods doesn’t immediately make me feel better.

After many false starts, I re-gave up all the sensitivity inducing foods in August, and was pretty irked when my heartburn continued for weeks.  But like last year, I suddenly noticed that only do I not have heart burn, but I haven’t for weeks.  I forgot that it was a thing I had.  And sometime in the last three weeks my skin became flawless.

No, one subject-aware case study does not prove a thing.  But when you consider how much the subject wanted the opposite result because that was where the ice cream was, it becomes deserving of further study.

HAES pre-check

I’ve been meaning to do a “science of fat and health and food” series for a while now, but have never quite gotten it together. There’s too much stuff I remember reading in some blog years ago but can no longer find.  The library has finally delivered Health at Every Size to me (just in time for Thanksgiving), and I’m hoping to use that as both a serious source and a jumping off point for other research I want to do.  In the spirit of inquiry, here are my basic beliefs, as cobbled together from an undergrad biology degree, personal experience, things people said on the internet, and scientific studies I read the abstracts of.  When possible I’ve included a citation but mostly this is just stuff from my brain.

  1. Some diets are lead to a better functioning body than others.
    1. The healthiest diets supply all necessary trace nutrients, including ones we haven’t identified as necessary yet.
    2. Protein, fat (of multiple kinds) and carbohydrates are all necessary for proper functioning.  Right now a lot of people are pretty sure that you should minimize carbs and especially sugars, but 20 years ago they were equally sure fat was evil, so I’m unconvinced even though their numbers look very shiny.
  2. Exercise is super good for you right up until the point it is super damaging.
  3. Despite our astonishing lack of genetic diversity, humans have a pretty wide range of how they react to identical food and exercise inputs.  Additionally, the same person can react differently to things over time.
    1. For example, people’s beliefs about the deliciousness of the milkshake they are about to receive affects ghrelin production, which definitely affects satiety and probably affects nutrient and calorie absorption.
    2. Medication can do the same.  Cortisol makes you gain weight. Several psychiatric medications lead to severe weight gain.  Hormonal birth control definitely used to make you gain weight. Many scientists claim the newer drugs haven’t been shown to do so, but my feeling is that “baby chemicals lead to weight gain” is the default assumption and the burden on them is to prove it doesn’t.
    3. Past deprivation, including in utero, can decrease basal metabolic level, or make it more likely to decrease in the face of further calorie deficits.
  4. At the same time, people are remarkably resilient to environmental changes.  A given person can eat a wide range of calories and stay at the same weight.  No one understands why.
  5. So while calories in/calories out is literally true, in the sense that everyone is taking in and using calories, it’s not useful, because so many things affect intake and output.
  6. It is possible to have an excellent diet and exercise routine and still be fat.
  7. But any given person will probably be fatter the worse their diet and exercise.
  8. When you tease these out, fat is mostly a symptom of things that lead to bad health, not a cause of bad health.  Extreme amounts of fat are hard on the joints and heart.  But all evidence says (good diet, good exercise, 40% body fat) > (bad diet, no exercise, 20% body fat)
  9. Nonetheless, the general and medical public alike seem extremely fixated on fat, and this is hurting fat people.
  10. Shame around fat seems to contribute to both fat and the negative health outcomes associated with being fat.  Shaming fat people for the health is right up there with rescuing prostitutes by arresting them.
  11. To the extent fat itself affects health, the ideal body fat % from a health perspective is much higher than the ideal body fat % from an American aesthetic perspective.
  12. Lab animals are fatter than they were a generation ago despite provably identical conditions.  This has got to mean something about our food, and it’s probably not good.
  13. It is possible to be both fat and undernourished.  Most poor Americans are.
  14. Your body needs calories to run.  Faced with a calorie deficit, your body may choose to cut programs (like the immune system, or thinking) rather than dip into savings (stored fat).  This means that maintaining even an “unhealthy” weight may be the healthiest choice a person can make.

I Swallowed A Bug

Here are the arguments in favor of bug eating:
  1. Relative to traditional meats (chicken, cow, pig, sheep), bugs require many fewer resources. (This and all future comparisons will be done on a per unit edible protein basis, rather than per unit animal weight)
  2. Bugs have more trace nutrients and less fat.
  3. We care less about bug suffering than chordate suffering.  Possibly we don’t care at all.
Here are the arguments against bug eating:
  1. Bugs are gross.
Here is where 28 years of being unable to digest food becomes a super power.  Most food and essentially all protein sources strike me as gross.  So bugs aren’t that much worse than any other source, and I have a lot of practice overcoming disgust in order to eat.
My friend Brian held a bug eating night.  He explains the rationale and practicalities pretty well, so I’ll restrict myself to talking about my personal experience, which can be summed up as “a million times better than I thought it would be.”
For background: I’m trying to train myself to eat meat.  This quarter I’ve taken to cutting off slivers of salmon (for the omega-3s) and more recently duck (which is a wonderful combination of delicious when dead and malicious towards conspecifics while alive, which makes it feel a little more moral) and sauteing them until they’re charred through.  When I say slivers, I mean slivers.  I’ve been working on duck for a week and I eat at most two fingernail-clipping sized bits, prepared and eaten separately.  For salmon I might do as much as 1/2 the volume of my pinky. I have small hands.
I pre-committed to eating at least one cricket, but that was all.  The other bug was supposed to be waxworms, and waxworms are squishy.  I don’t do squishy even when it’s not bugs.  And I was going to be extremely proud of myself for just that one cricket.  Eating a new anything is a big deal for me, and it takes time to adjust.
When the moment came I ate several (along with some HCl pills), and walked away, supremely satisfied in myself for trying a new thing and not freaking out about it.  And then I started getting that itch to eat more, that means the thing in front of me has some trace nutrient I’m short on.    So I did.  And I asked for some to take home.
I got off easy on the waxworms because they were burnt so badly they ended up not serving them.  But there were mealworms.  Mealworms were served as taco fillings, but as it turns out I’d rather eat a bug than a taco (the variation in textures freaks me out).  Mealworms were wetter and more fibrous, so you had to chew them more (although don’t skimp on chewing crickets, catching a leg in your throat feels gross).  The had their own taste, which I didn’t care for at first but could probably grow to be okay with.  I think I like it better than chicken (aka bad tofu) and beef, but not as much as duck or pork, and by pork I mean bacon.
At the end of the night I had a slight stomach ache.  I’d brought HCl but no digestive enzymes, and my stomach was clearly struggling to keep up.  But I get that with all new foods and any significant amount of protein, so I don’t hold it against the bugs.
Some of ease of eating was undoubtedly the environment.  Brian, John, and their blogless roommates have a pre-existing tradition of communal meals that I love, and that makes eating easier.  it was also supremely gratifying to have other people share my attitude that the food in front of us was gross but we were going to eat it anyway.  Constantly being the only one that thinks that gets really lonely.  I flinched a little bit when I went to eat the cricket leftovers this morning.  But then I ate them, and it was fine.  Definitely better than duck, and duck is delicious.
Honestly, the biggest down side is that for all that bugs take many fewer resources than chordate meat, they are currently much more expensive.  One pound of edible cricket is ~$13/pound, which is as much as the grass fed free range humanely cuddled duck I get at the fancy grocery store.  I could probably grow them at home at essentially no cost, since they can live on food waste I would otherwise toss, but I’m not yet committed enough to deal with the noise.  But even at this price I plan on eating more bugs.

Pain, part 2: Options for Treating Pain

Anesthetic (e.g. Novocain):  This is a very good option for when you need to block an extraordinary amount of pain in a very specific area for a short period of time (e.g. dental work).  However, as someone who received nerve damage from surgery that exactly mimics the effects of local anesthetic, I can tell you that it is not a long term solution.  Feeling nothing is actually very weird, and makes it easy to injure yourself.

Non-steroidal anti-inflammatories (e.g. ibuprofen):  These are great for occasional use, and have their place for long term pain caused by inflammation (e.g. arthritis).  But they carry some heavy risks for long term use.  One, inflammation is often a helpful reaction.  Topical NSAIDs helped my cat’s pain but retarded the growth of blood vessels in the eye which ultimately made the problem worse*.  Suppressing a fever can prolong illnesses.

NSAIDS are also hard on the stomach, which is bad for everyone, but especially bad for someone like me, who has long running stomach problems that interfere with my ability to absorb nutrition.  I completely wrecked my stomach with naproxen the week before surgery.

COX-2 inhibitors are a subclass of NSAIDs that target pain pathways more specifically, while sparing the gastic pathways that cause so many problems.  The problem is they also increase the risk of coronary events, to the point many were taken off the market and others restricted to single use post-surgery.  They’re so out of favor for pain relief that the three different medical professionals I begged for dental pain relief didn’t think to suggest them, even though I have many gastric risk factors and essentially no coronary risk factors.

Even before realizing COX-2 inhibitors might be perfect for me, I was very angry that they had been taken off the market.  The coronary risk was limited to a small subset of patients, of even of those, some might very well choose to live a shorter life in less pain, because pain is depressing.

Non-NSAID analgesics (e.g. tylenol and asprin): You know how new drugs like to advertise themselves as “safer than asprin?”  That’s because asprin is actually pretty dangerous.  Not super dangerous, but dangerous enough it might well be denied FDA approval today.  Asprin is also a blood thinner, which is great for coronary patients but terrible for dental patients because it can melt the blood clot protecting the surgical site, leading to dry socket.  Some descriptions down play dry socket, but it is in fact both extremely painful (because it exposes a nerve to open air), and dangerous (because it leaves the wound open to infection).   Tylenol is the world’s worst way to commit suicide, because there are several days between the point of no return and actual death, and they are extremely painful.

Opioids (e.g. heroin): I’m told these are super fun for some people, but I have had many different kinds over the years (as one dentist after another fucked up trying to fix my mouth), and I hate them.  The milder ones (everything short of percoset) do nothing for me, and the stronger ones (percoset) are so supremely unpleasant I would rather be in pain.  The only exceptions were when I was literally dying of norovirus, and whatever opioid they gave me was apparently integral to me not dying, and when I got dry socket.  And even with dry socket, I only took them to sleep, because they were just so awful. I refused to even get a prescription this time, because they just don’t work for me.

But even for people who find opioids tolerable, they have serious risks.  They depress respiratory function, cause constipation, and reduce mental function.  They’re insanely addictive on a chemical level- which doesn’t mean everyone who takes them once is hooked forever, but does mean that most people who take them will go through an unpleasant withdrawal period, no matter how “legitimate” their reason for use.  People develop tolerance to the pain relief faster than to the negative side effects, and quitting them may leave them in more pain than they were when they started.  For all these reasons, opioids are pretty much exclusively used for acute pain management and terminal patients.  Doctors who stray outside this risk serious sanctions from the DEA and FDA.  Even if I found opioids tolerable, there is absolutely no way I could have safely used them for the months of surgery + recovery I am going through.

And because I’m working my cat into everything: he doesn’t like opioids either.  Even after having four teeth pulled he fought me on taking his medicine, and then he just stood around in a stupor and drooled.

Tricyclic antidepressants: This is a cutting edge use of a very old drug.  I was prescribed topical doxepin by the doctor who did the research proving it was useful for oral pain- and even then, he was researching a different kind of oral pain.  It had some ugly side effects: I fell asleep immediately upon taking it, and couldn’t stand being touched (anywhere) the next day.  It left some numbness that lasted indefinitely- when I ate spicy food I could feel in my throat where the liquid had trickled down.  On the plus side- it left some numbness that lasted indefinitely.  That was a huge improvement over the shooting pain I’d had before.  I eventually stopped because the permanent effects had boosted me to the point it didn’t hurt that much, and the side effects were getting worse, but it was overall a great experience.  If I hadn’t found something better it’s what I’d ask my doctors for now.

Capsacin (aka spicy food): This really only works for dental pain.  When you eat capsacin it activates all your pain receptors at once.  Which hurts a lot, but then you’re good for a couple of hours.

Cannibidiol (i.e. marijuana): This one isn’t as well researched as the others because it’s illegal at the federal level (although, I must stress, legal in my state for both medical and recreational use).  But everything we know about it is awesome.  People tend to use THC and marijuana interchangeably, but that’s not true at all.  Any given strain can very in the amount of THC and CBD, and some strains may not have any THC at all, or the treatment may not activate it.  THC causes a lot of the symptoms traditionally associated with marijuana use, like munchies everything being funny.  CBD causes nerves to stop hurting for no reason, and may do a bunch of other awesome things like reduce inflammation, encourage bone growth, decrease anxiety, fight cancer, and (I can only assume) whiten your teeth while you sleep.  There is essentially no way to kill yourself with it** and there’s no physical dependency.  I used this off and on after all three surgeries, and my use naturally trailed off after each one.  It either doesn’t have any effect on me mentally, or the effect was less than the pain it was stopping.

THC may work synergisticly with CBD.  In my case it makes me sleepy, which is a terrible trait for a recreational drug but an amazing one for convalescent therapy.

A note for dental use in particular:  you are not even allowed to use a straw, so you definitely cannot smoke anything.  The nice people at the medical dispensaries have precisely dosed pills, and if you are lucky, CBD tinctures.  These are meant to be taken sublingually, but if your pain is in your mouth you can apply them to the area and everything stops hurting really really rapidly.  It gave me an amazing sense of control over my pain and enabled me to take more risks, in terms of eating and talking to people, which really sped up my recovery.

I don’t want to get too much on the “yay marijuana” bandwagon, because it’s entirely possible that as its usage becomes more widespread we’ll find out it has some rare but nasty side effects too.  But I do think it’s a travesty it is treated as worse than ibuprofen or alcohol, when it is clearly better.

*I think his infection was also resistant to the first antibiotics they gave him.

**Weirdly, this may be true for humans but not pets.  When I investigated using CBD to treat pain from my cat’s corneal ulcer, I discovered that we are pretty sure there is no amount so high it can kill your pet in one sitting, but chronic use may lead to something resembling serotonin syndrome (aka the reason you have to be so careful when taking MAOI inhibitors).