About the guest: Nicole Avena, PhD is a neuroscientist at Mount Sinai. She studies the effects of sugar and diet on animal behavior and the brain. She is also the author of, “Sugarless.”
Episode summary: Nick and Dr. Avena discuss: drug addiction vs. food addiction; glucose, fructose & artificial sweeteners; the extent to which sugar consumption can drive dependency & withdrawal; fructose metabolism & live health; sweetness & palatability; ultra-processed foods; and more.
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*This content is never meant to serve as medical advice
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Episode transcript below.
Full AI-generated transcript below. Beware of typos & mistranslations!
Nicole Avena 1:29
So my background is that, well, I guess I should start with where I am now. So I'm a associate professor of neuroscience at Mount Sinai School of Medicine in New York City, and I'm also a visiting professor of psychology at Princeton University. My background is that I am interested in how the brain is affected by the foods that we eat. And I started off on this journey when I was a grad student at Princeton. I worked there for my PhD to study neuroscience and learn about the brain, and our lab since then has been focused on this idea of food addiction and trying to better understand our modern food environment and how the different foods that we engage with these days are affecting our brains in ways that are perhaps not good for our health and can be contributing to Addictive overeating. So that's essentially what we've been looking at and thinking about in my lab, and what I pretty much think about all the time.
Nick Jikomes 2:35
Okay, so when we talk about addiction, you know, it's a subject I've covered before on the podcast, but you know, for those who haven't learned too much about this, maybe let's start with drug addiction and then talk about the extent to which, you know, there is such a thing as food addiction, and foods, you know Do or do not behave like addictive drugs do. So from the standpoint of an addiction biologist, when we think about drugs of addiction, right? What is addiction? How do you define it and what characterizes it?
Nicole Avena 3:01
Yeah, it's an important question, and I spent a lot of time, especially early in my career, looking at that very question, because when we think about what is an addiction, we have criteria that we can apply. So the American Psychiatric Association in their Diagnostic and Statistical Manual of Mental Disorders, the DSM lays out the criteria that need to be met for what's referred to as substance use disorder. And it's important to keep in mind that this is a spectrum, so you can have mild, moderate or severe substance use disorder, and so depending on what your substance is, that may or may not be terrible, right? So obviously, if you have, you know, a major substance use disorder for something like heroin, it's going to potentially cause you to, you know, overdose, and you're going to have a lot of problems. It's an illegal substance. But if you have, you know, major addiction to caffeine, and you're just drinking coffee all day long, then maybe it's not going to be so bad. So it really depends on the substance and the severity of the substance. So what we've been doing essentially, is taking these criteria for addiction, and there's a variety of different categories of criteria, some of them are, you know, based off of the way in which the substance works in our bodies. So you know whether or not you experience tolerance to the substance, whether or not you experience withdrawal signs if you go off the substance. But some of them are also social constructs. So you know some of the criteria for addiction are built around whether or not you know you could miss work because you're using the substance. And obviously you could bring coffee to work so you don't have to miss work to use coffee or caffeine, but you can't bring other things, you know, to work all the time that maybe people are addicted to. So the criteria, again, there's room for discussion there. I think, I think those could be better defined, but that's another topic. Yeah, but in any case, how does food fall into this? What we've been doing is basically taking those criteria, and we've conducted experiments, both pre clinical and clinical, to basically just test whether or not Ultra processed foods, or sugar in particular, can produce those criteria that are associated with addiction. And you know, much like there's plenty of drugs out there that aren't addictive, there's plenty of foods out there that aren't addictive. But what we've been finding is that the foods that are considered Ultra processed foods that have excess amounts of sugar in them seem to fall into this category where the DSM criteria for addiction can be met when the substance of abuse is that food.
Nick Jikomes 5:42
So, you know, when we think about addiction, we can think about it behaviorally. We can look at what animals or humans do in response to consuming certain substances. People often talk about, you know, dependency and compulsion. Dependency, basically being in the absence of the thing that you're addicted to. There's some kind of withdrawal symptoms. You feel bad because you've, you've become dependent on it, and then compulsion being, you know, how strong is the pull to consume the thing? Will you want to go consume it, even at the expense of doing other things that are, you know, normal or adaptive in your life? And then, you know, the other way we can think about this, which I'm sure we'll talk about, is the actual effects on the brain. How do different parts of the brain light up? What are the mechanisms involved in response to consuming certain substances that are addictive, and how does food look in comparison to drugs of addiction? So when we think about this behaviorally in terms of what animals do, the compulsion, the dependency side of things, can you start off with just talking a little bit about what are some of the clearest examples of a food that drives addictive behaviors, akin to what we see with addictive drugs. Yeah,
Nicole Avena 6:46
so in terms of the behavior, which is very important, because that kind of lays the groundwork for further exploration in terms of the brain mechanisms, what we've seen is many of the behaviors that you would see in animal models, where an animal is, you know, dependent on alcohol, for example, there's certain behaviors, seeking behaviors that they'll engage in that we also can see happening with sugar. So, you know, again, things like building up a tolerance, so needing to consume more and more of the substance in order to get the same euphoria or satisfaction that you used to get from having less of it. That's certainly one of the behaviors that we've seen. Also, like I mentioned a bit earlier, withdrawal, if the substance is not available for a period of time, then we are able to see both clinically pre clinically signs of withdrawal emerging, and what this looks like when it comes to food is similar to what it looks like with tobacco or what it looks like with caffeine, where, you know, depending on, you know, the severity of the dependence, people can experience feelings of irritability. People might feel weak or lethargic, and again, you know it's going to vary depending on the individual, and you know how much of the substance they've been consuming and for how long. And then, in terms of cravings, that's also another behavior that we've been able to capture. In terms of the research, we've seen that an animal models animals are willing to work harder for longer in order to get access to a substance like sugar or ultra processed food. And that's similar to what you would see if an animal was dependent on nicotine or, you know, on morphine, even where they're willing to lever press, you know, 5000 times in order to get a little hit of it, whereas if it was a different substance, it wouldn't be worth it, right? So they wouldn't even bother liver pressing to get access to it. So that willingness to work is is a key. Because even though we're seeing this in animal models, we also, you know, can see it in humans as well, in the sense that people will articulate to us that they crave certain types of foods, people don't typically say, Oh, I'm craving, you know, broccoli. But you know, when they are especially in an emotional, dysregulated state, like stressed or anxious, they tend to experience a desire for foods that will satisfy them. And again, that's related to the brain mechanisms, yeah.
Nick Jikomes 9:20
And I suppose a key thing here is that we whether it's the dependency and withdrawal side of things or the compulsion the seeking side of things. We're, you're seeing this behavior, it sounds in for certain foods and not others. And by analogy, you know, we see this. We see this type of thing for certain drugs, but not others. Animals work very hard and exhibit cravings for cocaine at a rate that's much higher than say, you know, LSD or whatever,
Nicole Avena 9:44
right? Exactly, yeah, and that's where it gets tricky, because when we a lot of this, you know, in hindsight, it's one of those things where you are regretful of calling something something, right? Because when we first started publishing about this work, we were. Using the term food addiction, because we were looking at food and seeing that some of it's addictive. But what's happened now is that, you know, yeah, not all food is addictive. So, you know, the terminology has morphed a bit, and some scientists will talk about Ultra processed food addiction, which I guess is a better way to characterize it, although it's kind of a mouthful, but one thing that I kind of think, and perhaps we could get into this in a few minutes, that is almost a solution that would help a lot of this would be if we had a different category for these different types of foods. I don't necessarily think the term food should be this ubiquitous umbrella. It encompasses everything from carrots to pop tarts, because Right, right, very big differences between those things. So that's where I'd like to see, you know, some changes in terms of how we think about this from the addiction side, for sure, but we also need to think about, well, what is a food?
Nick Jikomes 10:54
And one thing I want to adjust up front for for listeners too, is when we talk about addiction, even if we're talking about drug addiction, a drug can be highly addictive. That doesn't mean everyone who's exposed to it becomes addicted. Even highly addictive drugs like, say, cocaine, only, usually a minority of individuals in a population, whether it's rats or mice, whether it's humans, will actually become compulsive drug seekers after multiple rounds of consumption. And so I just kind of want to say this up front when we think about food, because, you know, a lot of people will say, well, sugar can't be addictive. No, I don't know anyone who's addicted to sugar. I eat sugar. I don't have a problem with it. But I think important thing to emphasize here is, if something is addictive or has an addiction liability, that does not mean that everyone exposed to it will become a compulsive seeker of it
Nicole Avena 11:41
absolutely and, you know, just like people can occasionally, you know, smoke cigarettes or occasionally drink alcohol, then just not consume it. It's the same with food. And I think part of the issue, though, that we see with food and not with things like drugs and alcohol, is that we know where the drugs and alcohol are, right? You know, when you go in your refrigerator, if you grab a beverage, whether or not it has alcohol in it, and you have control over that, if there was little bits of tobacco, you know, nicotine sprinkled and, you know, everything that we eat, then I have a feeling a lot more people would be addicted to nicotine because they're consuming it unknowingly. That's what's happening with sugar, right? So when you look at our food supply, when you look at the processed food, which we are reliant on, you know, there aren't enough farms to feed all the people. So I'm not saying we shouldn't have processed food, but when we look at the ingredients, there is sugar in so many of these food products, and the vast majority of them, and often people are consuming it and they don't even realize it, yeah. And so I do think that what does make sugar different from the addiction standpoint, is that more people are at risk for getting that addiction, or developing that addiction just simply due to, you know, the fact that they're exposed to it so much more than other drugs and alcohol.
Nick Jikomes 13:06
Yeah, the sugar is often, you know, effectively camouflage. There's not necessarily a big label that says this much added sugar. And I'm sure we'll get into some of the, yeah, the tricky techniques that are used to sort of hide the true amount of sugar and things. Before we get into some of that I want to talk about. Let's talk about sugar addiction and the evidence. Supporting that it is, in fact, can be addictive. But when you say sugar, what exactly do you mean? Are you talking mostly about glucose, fructose? Does it depend? How do we start to unpack that? You
Nicole Avena 13:34
know, I when I talk about sugar, I'm mostly talking about pretty much anything that's sweet. To be honest, we started off looking at sucrose as the primary sweetener that we were studying, but we've looked at other sweeteners, high fructose corn syrup, and pretty much all the other ones that are out there. And what we're finding from the research is that it's the sweet taste that seems to be driving that addiction, like response. And so you know, when we do studies, and we've done lots of studies looking at the brain, what we see happening is that when sugar is consumed, it can release dopamine in the nucleus accumbens and other areas of limbic system. That is the same pattern of release you'd expect to see with something like a drug or alcohol, and you don't typically see that with food. Normally, when an animal eats something, it doesn't release dopamine in the brain. It will if it's a novel food, and it's the very first time you've ever tasted that particular type of ingredient or that particular cuisine, because it's more of an orienting response where, you know, it's a survival mechanism. We're kind of built to be wary of new tastes, yeah, because when we evolved, it meant if you tasted something funny, it could kill you. So
Nick Jikomes 14:50
there is an aha moment for animals. We're like, Ah, I can eat that. It is okay, yes.
Nicole Avena 14:55
So what's interesting though, is that, you know, when we look at the brain. Yet, most foods don't release dopamine, but when we look at Sugar, it does, and it's interesting, because it often does depend, too on the amount of sugar that's being consumed. When we're looking at a bolus of sugar being consumed, that's going to release dopamine, whereas, you know, occasional sips of sugar here and there don't have that effect on the dopamine system. So it's almost like we've used the term binging. I've gotten away from that because there's such clinical ties to the term binging. It's just really excessive consumption of sugar that causes this dopamine release, and that's what's happening. You know, for most people, most of the time, is that they're releasing dopamine in response to eating those cookies or eating, you know, whatever the substance might be that they're eating. And so I think that's really, you know, a big issue that we need to keep in mind, in terms of the fact that, you know, these foods are affecting the brain in this way, and it doesn't stop at dopamine. I mean, we've seen changes in the endogenous opioid system, the endocannabinoid system, again, all of which basically parallel what happens when you look at the brains of animals that are addicted to drugs or alcohol. And
Nick Jikomes 16:10
so if you put animals in a paradigm, the same paradigm you put them in to assess the addiction liability of a drug, they they exhibit the same basic behaviors in response to sugar. Can you? Can you? Just give us like a concrete example of that? Concrete
Nicole Avena 16:22
example of that? Yeah, so are you talking about from like, the neuroscience standpoint or from the behavioral standpoint?
Nick Jikomes 16:31
Well, let's, let's take them one at a time, but starting with the behavior. Okay,
Nicole Avena 16:35
so yeah. I mean, when we do our studies, like, I'll tell you, we started off looking at developing develop an animal model to study this. First of all, because when I started doing this work, it was the year 2001 and I had just joined the lab at Princeton, and I was talking with my advisor at the time about what we might study. And you know, just through some discussions, this kind of came to be to ask the question, well, could food be addictive, just like drugs and alcohol are addictive. And it came out of the fact that obesity, we were starting to hear more and more about it in the media as a public health concern. And you know, to me, it just didn't seem that it could all be about personal responsibility and it could all be about, you know, willpower, which was kind of what the mantra was back then. And looking at our changing food environment, we started to kind of see, well, there's a lot more sugar in our environment than there was 30 years ago, and now there's a lot more obesity than there was 30 years ago. So perhaps that has something to do with it. So when we developed this animal model, we basically wanted to assess, you know, whether or not binging, withdrawal and craving, which are kind of like the triad of behaviors associated with addiction, would emerge in response to animals that are just binging or given daily access to large amounts of sugar. And so we gave them a sugar solution. They always had water to drink too. So they were never forced to drink it for hydration. They always had food available, so they were never forced to consume it, just for nutrients. And what we ended up seeing was that, in fact, the animals that had this extended access to the sugar solution would develop binging. They developed signs of tolerance. So, you know, they would have larger, larger binges throughout the day, they'd also show signs of withdrawal, and this was measured using measures of depression. We also use the elevated plus maze to assess anxiety, and we also had somatic indications that we were assessing like, you know, changes in blood pressure, changes in body temperature, and even just like ultrasonic vocalizations of distress, essentially that they can be to each other, that we can pick up using different devices. And then lastly, the craving part, that really, you know, can be measured in animals, even though they can't tell us they're craving something, we can do different experiments to see how hard they're willing to work to get access to a substance, and that's usually an indicator that they're craving. So we use opera conditioning to do that. And you know, essentially, what happens is that, you know, we're able to demonstrate these behaviors in animals that are having this excessive consumption of sugar, but not in animals that are eating regular rat Chow, or animals that are having sugar just occasionally,
Nick Jikomes 19:25
yeah, I guess one of the keys here is that you said they always had access to plain water. They always had access to other foods. So they can opt in to doing this. And even though they have that option, and it's not necessary for them to hit their nutrient or water requirements, they often will choose to do this. And the binging becomes more frequent, it becomes bigger. And you can essentially, you can essentially measure things like a mouse sugar hangover, yeah,
Nicole Avena 19:49
basically, that's what, what we've been doing. And, you know, also in people too, because there's been some scales that were developed, and ways in which a lot of the work that we started off doing in our. Or animal models, could then be translated into humans. And so many of these things can now, you know, and again, with the use of neuroimaging techniques, we can basically see this happening in humans as well. And I think one of the things that you know, for me, is so exciting, is that we're able to, you know, capture a lot of what's happening in the brain, because a lot of times behaviors, yes, they are indicative of what's going on in the brain, but to be able to really see these neurochemical changes happening in real time, because a lot of the techniques that we were using at the time of these initial studies were in vivo micro dialysis technique, so that basically allows us to cannulate the rat in the brain and extract extra cellular fluid while the animal is awake and moving. So they're basically running around the cage, tethered so that we can collect the sample from their brain. And they're eating, they're drinking, they're, you know, engaging in whatever behavior they like. And so to be able to see the rat drinking sugar, and then look over on the screen and see a spike in dopamine, I mean, it's really telling to see that happen.
Nick Jikomes 21:13
Yeah? So basically, you see all these behavioral signs the animal is is, in fact, becoming dependent or engaged in compulsive behavior. And then you're saying basically, what you've said so far is that you can see in the brain that the consumption of sugar by rodents is eliciting the same types of effects and same parts of the brain that you would see in response to an addictive drug. Yep,
Nicole Avena 21:33
absolutely. And you know, when you say it like that, it kind of sounds like, Oh, yeah. That makes a lot of sense. But I have to tell you, when we first were doing these initial studies, like when I was a, you know, early grad student, I would go to conferences and present some of our new stuff. It wasn't well received, and it was really just, it's really been over the past, I'd say, 10 years or so, that this concept has really gained a lot of traction. And I think, again, it has to do with the fact that, you know, we used to silo things so much like, addiction was over here, obesity was over here, and nobody really put the two together. But I think now we've gotten a bit more integrated in our thinking when it comes to medicine. And, you know, now, like addiction, medicine is something that people can become certified in when, you know, apply that to obesity and apply that to, you know, treating individuals who are struggling with their body weight. So I do think that, you know, we need to keep in mind that, yeah, I mean, there's been a lot of changes that have happened that have, I think, allow this to gain more acceptance, and hopefully that'll continue.
Nick Jikomes 22:42
And so in the experience you've described for animals, are we talking about when you say sugar water? Are you talking about sucrose here? Yeah.
Nicole Avena 22:50
So our studies initially, you know. And again, because we were trying to be careful scientists, we wanted to make sure that when we were using this model to test all these different aspects of substance use disorder or addiction that we were keeping things aligned. So we were using, typically, a 10% sucrose solution, and that's about the concentration that you would get of sugar in a can of soda, if you would have so that was where we started. And like I said, we've, we've kind of looked at other sweeteners, and we've published looking at high fructose corn syrup. We've looked at glucose at the end of the day. It really does seem to boil down to that sweet taste. One of the studies that we did we used sham feeding combined with in vivo micro dialysis. So what we did was we cannulated the stomach of the rat so that when they would drink the sugar solution, they wouldn't digest it. It would simply exit through the stomach, through a tube. And when we were to do micro dialysis on those animals, while they were sham feeding sugar so they could drink it, taste it, but not digest it, we saw that it was causing a release of dopamine, even though they're not digesting it, so just simply tasting the sugar was enough to elicit that dopaminergic response, and even with other sweeteners that have been tested, the whole sweetener world is a little tricky when it comes to rodents, because some rodents don't even detect the taste of Certain artificial sweeteners, just because they're so artificial they like,
Nick Jikomes 24:23
they don't have, like,
Nicole Avena 24:23
receptors for it, yeah, they just, they know to stay away. But yeah, so to me, it's, it's really more about the sweet taste. Now it goes beyond the addiction, right? I mean, obviously there's certain types of sweeteners, like fructose is going to have more of a negative impact on the liver than, you know, maybe other types of sweeteners would. So there are differences, for sure, terms of how these sweeteners affect the body, but you know, just coming from the addiction piece, it's really about the sweet taste.
Nick Jikomes 24:52
But yeah, so what you're saying is, if you sort of regress all the variables here, it's the level of sweetness is proportional to the level of C. King that you're going to get from the animal Absolutely.
Nicole Avena 25:01
And, you know, I think that's when we look at this from the public health perspective. I mean, that's the problem. Is the level of sweetness has just been slowly getting ticked up. And if you look at the amount of sugar that's in all the different food products that are on the market, it's so much more now than it was five years ago, 10 years ago, you know, going back, you can really see it. And then just the sheer number of products that have added sugar has gone up. So, you know, there's just, you know, I like to think about this from, you know, what are we going to see in 20 years? Because, I mean, there's sugar in so many of the different things that kids are eating, they're basically being raised to have this high level preference for sugar that, you know, basically means that they're going to desire to have things be really, really sweet. So it means they're going to be consuming more
Nick Jikomes 25:55
and more of it over time. Yeah. And, you know, one of the things I want to ask about here too is, well, if I step back for a second, I think about, sort of, why all of the biology is set up this way. And you know how things work under naturalistic or ecological scenarios? You know, if I think about addictive drugs, it's pretty it's pretty easy to think about, it's like, okay, the brain needs to have mechanisms to motivate the animal to do things. It needs to have natural forms of reward processing to tell it like, go for this, don't go for that. You know, develop preferences, develop motivations. And it's not surprising that, you know, you see substances like synthetic compounds that have, you know, super sized effects in this natural reward circuitry in the brain. You know, whether that's a psycho stimulant or an opioid or something, you're like, Okay, it's tapping into natural mechanisms that are for reward learning, but it's got a super sized effect effectively, because it's not, it's not ever anything that an animal is going to encounter in nature. And when it comes to something like sugar, sugar is, of course, something that animals encounter in nature, and so but they're still developing these addictions, as you've just told us, is the way to think about this, that in nature, the dose and the frequency with which an animal will encounter something like a natural sugar reward is limited, whereas in artificial settings concocted by humans, that's not the case. Yeah,
Nicole Avena 27:17
absolutely. And you know, if you think about it, if an animal, or even us as humans, if we were to wander into an apple tree, right? Are you going to eat the whole tree worth of apples? No, we have satiety mechanisms built in where, you know, there's fiber in the apples, and we get full from the calories, and so our jaws get tired from having to masticate the apple to chew it up. So we have these sort of built in breaks, if you will, to slow us down, to stop us from over consuming so that limits the amount of sugar that we have, and also just nature in and of itself. I mean, the world isn't covered in apple trees. You have to find one. It has to be during the proper season. It has to be, you know, something where the Apple hasn't fallen off the tree and it hasn't spoiled. It has to still be, you know, safe and attached to the tree. To
Nick Jikomes 28:10
do work, to find it, you might have to fight for it. You've got to chew it. It's not a liquid bolus of straight sugar, exactly.
Nicole Avena 28:16
And I think that's, you know, really, what we're facing right now is that, you know, a lot of the work is taken out. I mean, again, it's wonderful that we have refrigeration and we don't have to, you know, plan our own apple trees. But it does mean that, you know, we get access, and the amounts of it, I think, you know, in terms of taking an apple, let's say, and then, you know, making apple juice, yeah, you can, you know, how many apples would you need to make a glass of apple juice? Right? I mean, that's quite a few apples. No one's going to sit there and eat all those apples. But again, we're bypassing a lot of the barriers that biology has put in place, whether it's from nature or whether it's just from, you know, satiety mechanisms. When we take a look at a lot of these processed foods, and that's what makes them so easy to over consume, and that's what makes it, you know, very dangerous. We weren't designed to have that much sugar. Our bodies, again, were built differently and have not been able to adapt to have the ability to put on the brakes when it comes to these processed foods, just because it's come on the scene so quickly. Yeah,
Nick Jikomes 29:29
and I think this is important, there's a lot of different satiety mechanisms that come into play at different timescales, but in nature, these things are sort of all stacked on top of each other in a way that we've just gotten around through being able to engineer our own foods. And I think it's important to really emphasize this. One of my biggest pet peeves that certain types of people bring up in this discussion is, you know, people will sort of cherry pick from the ethnographic record. They'll say, What about the Hadza people? They eat 60% of their calories from honey, blah, blah, blah, blah. Lot, and it's like, well, yes, but they also have to climb a tree and then fight off bees to get the honey. They eat it with the waxes and the larvae. And it's seasonal, so there's, there's always baked in limitations, right?
Nicole Avena 30:10
Exactly. And, you know, again, I think we also need to keep in mind like, yes, what we're eating is important, but, like, you're suggesting, you know, there's a lot of other stuff that contributes to, you know, stressors in our environment that you know can lead us to, then want to overeat sugar, you know, that's one of the key components, I think, that often doesn't get discussed. We have a lot of other things that contribute to, you know, what we eat, and you know how that's going to have an impact on our body? You know, if you're an ultra marathon runner, like you probably could get away with eating more sugar, and, you know, having a lot of these things, compared to somebody who maybe is, you know, very sedentary or just has a regular office job and doesn't really get that much exercise. So it's, it's all, like you said, Yeah, I do not like the cherry picking either, because it leaves out the whole, like holistic aspect of this, that this is, there's interconnected components that we need to keep in mind. And
Nick Jikomes 31:13
I guess this relates to the question, a sort of a similar question that I often see out there, in the in the in the zeitgeist here, which is, you know, sometimes people will make the argument, glucose can't possibly be bad for you. Sugar can't possibly be bad for you, because, even, seeing, all organisms are designed or evolved to use glucose as a fuel source, it's efficient substrate for ATP production. So, you know, it can't be bad for you in any context?
Nicole Avena 31:40
Yeah, I've heard that. And, you know, anything could be, I mean, that's like saying, like, if you just keep putting gasoline in your car until it's covered, you know, leaking out that how? How could that be bad for your car? Well, yeah, that's just because the car was only designed to hold a certain amount of gasoline. Same with our brains and our bodies when it comes to sugar. I really don't think we were designed to, you know, have products that we're consuming that have, you know, 50 or 60 grams of sugar in one serving. You're never going to find that every
Nick Jikomes 32:19
day all year. Yeah, exactly.
Nicole Avena 32:21
And so, you know, I think we need to keep in mind that, you know, yes, we our body uses glucose as a fuel, but our body can make glucose as a fuel. We don't need to eat it in order for our body to make it. And so I think that, you know, there is a bit, I think, of miscommunication out there around actually how much sugar we need to survive. There's, there's plenty of people who really hardly eat any sugar. Look at all the people who do like hardcore keto, for example. You know, they might not be consuming carbohydrates in a meaningful way, but they're still alive and walking around, because their body is going to produce the glucose for them. Now, I'm not advocating, you know that as a long term solution, but it just proves the point that, you know you don't need glucose in order to survive, because I think that you don't need to eat it. Exactly, yeah, and you certainly don't need to eat, you know, 50 grams per serving of it.
Nick Jikomes 33:22
Yeah, yeah. One of the things I want to talk about here, we'll get into things like individual differences, differences between the response to sugar consumption and say, obese for this non obese people. But I guess sort of the larger point here is, if we look at the drug addiction literature, what we find, again, as we said before, only a subset of individuals will end up becoming addicted and displaying all the hallmarks of addiction after exposure. Some won't display those things even after exposure. And you know, even even when you look at the initial brain response the very first encounter with an addictive substance like cocaine, say, some individuals will have bigger responses in some of this dopamine reward circuitry than others. And you know, for reasons that are still mysterious, we don't really know where those differences arise, but there are differences between people that will just, you know, make one person more prone to have a rewarding response to something, whether it's a natural reward or a drug reward, than than other people will. And so I'm wondering if you could talk a little bit about individual variability here, maybe brain responses, and, you know, the obese versus non obese individuals, things like that. Yeah.
Nicole Avena 34:30
So genetics certainly plays a role. We know that, you know, certain people just have a genetic propensity to become dependent on things, compared to others who maybe perhaps don't have that genetic propensity. Another thing that I think is important to keep in mind, and I mentioned this a little bit ago, is the stress component. You know, sometimes stress can be the sort of thing that pushes people over to utilize. Is a substance in order to combat stress or to combat anxiety. And so people who, for some reason, have you know the less of an ability to manage stress or to cope with stress, or have coping skills that have been employed to help them mitigate their anxiety and stress are at greater risk for developing an addiction and utilizing these types of substances like drugs or alcohol. And then, you know, I think individually, when we think about, you know, why some people get addictions versus why others don't, I think we also need to keep in mind history so aces scores that's advanced, excuse me, adverse childhood experiences. There's a lot of research that suggests that individuals who have higher aces scores are more likely to develop addiction. So you know, acknowledging that there is embedded trauma that can then manifest itself later in life, and sometimes that takes a form of developing an addiction. So I think all these things, you know, we can easily think about when it comes to addictions to drugs. And I also, too, think that in many cases, you know, these apply to food. But what's again, different, I the I will argue, is that, I guess, because of the availability of sugar, and because of the early exposure to sugar, more and more people are at risk for developing that addiction. Also, one thing that we should also bring up is this idea of cross sensitization, and so if you have a history of drug use, you're more likely to get dependent on a
Nick Jikomes 36:42
new drug because they all tap into the same core mechanism Exactly,
Nicole Avena 36:46
exactly. So that's why you know people you know will sometimes, like, warn their teenagers, like, Oh, don't you know if you smoke marijuana or if you smoke cigarettes, you're more likely to then, you know, get into harder drugs later on, on this whole, like gateway effect idea. And there's some truth to that, because, again, you're, you know, activating the brain reward system with these substances. And at some point that might max out, or someone might say, Oh, let me try this other substance for something different. And then, you know, it goes from there.
Nick Jikomes 37:20
And so yeah, and people get really strong opinions when it comes to this stuff. But what's, I think, what you just said is, what is incontrovertibly true is that, you know, any, any substance that can be abused will ultimately tap into the same, you know, dopamine based reward circuitry within the brain, and that circuitry itself becomes more sensitized with and develops tolerance to, you know, any one of these substances, and that can lead to a future increase in the likelihood of being sensitized to another one if you engage in consumption of that other thing Absolutely. And,
Nicole Avena 37:54
you know, I've talked with I gave a presentation to drug free America Foundation a bit ago, and one of the things that they wanted me to speak about was, you know, they have done a really good job of educating people about the dangers of drug use, but a problem that they face is that often people stop using drugs and develop obesity and end up eating and end up having diabetes. This is something you see happening, you know, just on a smaller scale for with people who are smokers, who stop smoking, they usually wait. And you know, part of that is because the brain has been sensitized to still want that reward. And since you're not getting it from nicotine or drugs you naturally
Nick Jikomes 38:42
seek to get it somewhere else.
Nicole Avena 38:44
You can get it from sugar, you can get it from processed food, and it's safer than the drug that they were abusing, at least. That's the, I guess, the way they view it, um, it's acceptable, it's ubiquitous, it's cheap, and it's, you know, not viewed as necessarily something that is bad for their health. And so that, again, underscores this whole concept of how cross sensitization does play a role.
Nick Jikomes 39:12
Yeah, and I wonder, so when we talk about the palatability of foods and the potential addictive effects that things like sugar can have. How does this tie into things like the obesity epidemic at large? So I would imagine, you know, so when we consume, when most people can consume sugar, it's usually not just straight sugar. They're not just taking a, you know, a scoop full of sucrose. They're not drinking, literally, a bottle of high fructose corn syrup. It's really these sugars added into other things. And so to the extent that that palatability is higher due to the presence of the sugar, to the extent that they become addicted, basically they're going to naturally be consuming more overall calories, right?
Nicole Avena 39:52
Absolutely, yeah. And I think that, you know, sugar is sort of the siren that. Stores people in, right? It's the thing that is, it's the tasty component to the substance that's being consumed. But with that comes additional calories. With that comes other ingredients that are added that maybe in and of themselves aren't necessarily like desirable or palatable, but they contain things that are going to add extra calories or add saturated fat or add, you know, things that aren't going to be healthful for us. Yeah, so I think it's it, you're right. It's not sugar that you know. But I think we need to keep in mind that, you know, we're we're designed to have, like, a a threshold of sweetness. And so children's threshold for sweetness is actually higher than adults. And so that's why kids cereals tend to have lots of sugar added on them. And kids always want things to be sweet, because they are actually living in a very different sensory world than adults. Are they actually the threshold for sweetness of what they prefer is higher than adults. And you know, it just goes to show, though, that, you know, it has to be calculated in such a way that it's palatable. It's kind of like an inverted U in the sense that there is this sort of optimal bliss point of sweetness. If you go below that, it doesn't taste that great. If you go above that, it's going to taste aversive. So things can be too sweet. And so that's why it is usually sugar added with other ingredients, so that it's not just, like 100% sugar that's doing things. Yeah, because
Nick Jikomes 41:30
I would imagine naturally, if there, if it wasn't an inverted U relationship, if it was truly linear, like, more sweetness equals more consumption than all of the food companies would simply be putting hundreds of grams and everything. Yeah, we
Nicole Avena 41:43
would be investing in the Domino Sugar Company, right? Because people would be, you know, popping sugar cubes all day. And no one is really doing that. Um, but it is, yeah, there is sort of this, but it's creeping up. And I think that's the thing. And I think what do we we are seeing is that, you know, the increasing amount of eating occasions that are happening does contribute to this as well. So if people are eating, you know, boluses of sugar that maybe they don't realize in terms of the portion size, or, you know, just in terms of the other ingredients that are in the product multiple times throughout the day, for many years, over time, over time, that's really going to add up and have a negative impact on their health.
Nick Jikomes 42:27
So, so, you know, we've talked about how sweetness is, is sort of a major component here. It's really the sweetness people are attracted to. Different sugars have different levels of sweetness. But ultimately, you know, we can think about, we can, more or less think about this in terms of the, you know, if something has an optimal level of sweetness, it's going to be maximally reinforcing. But other foods are also very tasty. I love the taste of many high fat foods that are very low in sugar. I love the taste of very savory foods. There's few things I like more than than, you know, the right cut of steak. How come we don't hear about those things driving this kind of compulsive seeking behavior?
Nicole Avena 43:07
I think it has to do with the fact that, you know, again, when we talk about things like, for example, steak, you know, it's, it's processed in the sense that you usually cook it a little bit right to make sure it's safe to eat, but it's, I think, more about the number of ingredients, and, you know, the ultra processed nature. Also, there's, again, going back to what we're talking about a bit ago, you know, we have these satiety signals that are built in when you consume a steak. You know, you have to chew it. It's you gotta cut it up. It's going to cause you to feel full after you eat it. And we see that isn't really happening with these processed foods, with the foods of the added sugar, because most of them do not have a lot of fiber in them, and there's really nothing that's pausing us to want to stop eating them. There's no barrier that is put in place to have people, you know, basically become satiated. And you know, if you think about this, sort of like balance of, you know, desire for reward and satiety, usually, you know, when you get some satisfaction, you have satiety going up. And that's kind of allows you to, you know, sit back and enjoy it, and then, you know, maybe get some more later on, if you get hungry again or want more reward, but if you have desire with no satiety mechanism in place, you know, there's nothing to stop people from just consuming until it's gone. And I think that's what's happening with a lot of these sugary foods and a lot of these highly processed foods that have added sugar and that makes them different from things that are still delicious and savory, like you say, but perhaps in a very different way.
Nick Jikomes 44:55
Are there any measurable differences between cologne? Sweeteners and non caloric sweeteners in terms of how reinforcing they are. Well,
Nicole Avena 45:04
we have looked at this a bit, and again, it goes back to the sweet taste. And so to me, you know, because people will often say, Well, if I just use a non caloric sweetener, is that going to solve all my problems? And I'll say, well, it might save you some calories, but it's not going to solve your addiction to sugar, because it's the sweet taste that's driving the addiction, like response. So when we have these non caloric sweeteners, you know, the brain doesn't know that it's not a caloric sweetener. The brain, actually, I think, probably gets confused by the fact that, hey, I just had this sweetener, but I didn't get any calories. So what's going on here, right? So, if anything, I think, causes there to be some dysregulation in terms of the way in which our brain processes the signal of sweetness, in terms of the reaction that typically happens of it containing calories, and over time, what the research has shown is that, in fact, people who use those non caloric sweeteners, especially if they're obese or overweight, they're more likely to be consuming more food later on. So you might save yourself, you know, 100 or 200 calories by having a diet soda right now, but at the end of the day, you'll end up consuming more overall in terms of calorie intake. So I don't necessarily see them as beneficial for most people, especially for those who are trying to, you know, deal with an addiction to sugar, because it's still activating the dopamine system in the same way. Yeah,
Nick Jikomes 46:32
I could even imagine, you know, based on my knowledge of the reinforce reinforcement literature, you know, if you decouple, so if you've got, you've got, you've got a non caloric sweetener, you've got the sweetness, you've got that taste, but you don't have the calories behind it. You're creating sort of a mismatch. I could imagine the basically the dopamine reward circuitry tuning down its response such that when you do, if and when you do get a caloric sweetener in the future, now it's you know, that that signal is actually going to be boosted later? Yeah,
Nicole Avena 47:01
because the reward, in many way, for our body is the calories, right? We need the calories. And I think that is what exactly. What happens is that, you know, we're causing these issues to arise later on.
Nick Jikomes 47:18
Can you actually like, can you, like in animal models, can you actually block the reinforcing effects pharmacologically, like you would by, you know, using like an opioid receptor antagonist or a dopamine receptor antagonist or things like
Nicole Avena 47:33
that. Yeah, absolutely. I mean, you could do that chemically by applying drugs locally that block the dopamine receptors or opioid receptors, and that's certainly one way in which, you know, you can assess, you know, aspects of reward. We haven't done much of that. We've looked at, you know, ways in which we could precipitate withdrawal. And interesting, you know, when we first started publishing some of our earlier studies, we were looking at dopamine, we were looking at other neurotransmitters, but we were also looking at MU opioid receptor binding. And so we wanted to see whether or not there was an increase in receptor binding for opioids in response to consuming sugar, and this has been shown in response using opioid drugs, and we did see that we have seen increases in opioid opioid receptor binding. What's interesting is that if we give animals Naloxone, which is an opioid receptor antagonist, we can precipitate withdrawal. So we can have an animal that's just, you know, drinking sugar, give them Naloxone, and they'll start to tremor, wet dog shakes. They'll start to show these somatic indications of withdrawal. So, you know, I think that's interesting, because you know, if you just take Naloxone and you're not addicted to an opiate, it's not going to do anything to you. That's why it's safe to, you know, Narcan, anybody you want, because it's not going to harm them. But the fact that, you know, sugar can affect the endogenous opioid system in a way that a drug like Naloxone can precipitate withdrawal, you know, really does, I think, speak to how powerful it is affecting that system.
Nick Jikomes 49:19
I want to talk about, you know, we've sort of mentioned, you know, we've talked about food addiction, sugar addiction, we've talked about drug addiction, and how all of the stuff taps into um, core circuitry that's for, you know, natural reward processing there, there has to be mechanisms, mechanisms in the brain that allow animals to distinguish different things, to prioritize them, to to assign a value to them, And to motivate the animal to seek certain things out. All of that comes with natural constraints based on, you know, limitations in the natural environment that of course, don't apply to the artificial world that we humans have created. I want to talk about what happens when you sort of block reward processing generally. Are you familiar? So. The sort of, I guess you would call them, maybe the first generation of weight loss drugs, the Ramona bond story. Are you familiar with
Nicole Avena 50:05
that? Oh, gosh, it's been a while. I remember reading about this, but it's been a while since I've looked at that literature.
Nick Jikomes 50:15
Yeah. So basically, the story there was, this is cannabinoid CV, one receptor antagonist. So Right? Cannabinoids give you the munchies. Everyone is sort of familiar with that. It's an antagonist of that receptor, and it was approved as a weight loss drug in Europe in the early 2000s so you can think of it as like ozempic version 1.0 or something. And people did lose weight. It was very effective. People started taking it, they started losing weight. They were eating less. But then it was bull for the market, and the reason for that is that people had a lot of psychiatric side effects, basically, depression, suicidal ideation and things like that. And sort of the flip side of some of the things we're talking about is, yeah, you can have too much reward, and it can spill over into addiction. But also, if you sort of block this whole reward processing system, it can spill over into things like depression and Anhedonia and things like that. Is there anything like that you've done, or anything you want to say there about sort of the flip side of this, you know, taking down the reward signals too far, as opposed to boosting them too far?
Nicole Avena 51:14
Yeah. I mean, I think, you know, if we talk about doing it pharmacologically, then yeah, like the Ramona box story, or even, like, you know, some of the modern day weight loss drugs that, you know, reduce people's desire to eat. I often question, and I know there's ongoing studies looking at this, you know, is it reducing their desire to have sex? Is it reducing their desire to, you know, go shopping, or, you know, other behaviors that are operating on that same reward system. So I do think when we look at this from a pharmacological standpoint, like, yeah, that is a very real concern. But I think my personal viewpoint is that we should be trying to look at this from the standpoint of, how can we change our food environment to make less sugar available in the sense that it's not in all these different products all the time? I don't think we really run the risk of like, having it go the other way when it comes to doing it naturally, like that, by just ingesting less sugar. But I do think that, you know, we need to keep in mind that you know this reward system, like you said, there isn't, like a cocaine reward system or a sugar reward system, or, you know, sexual behavior reward system. It's just one reward system. And so, you know, other aspects of our life are dependent on that system as well. And I think that's why, you know, we talk about, like, poly substance abuse, and when we talk about, you know, this link between, you know, when people are the throws of addiction to drugs or alcohol, they're struggling with their mental health, often it's because many of these things are connected in terms of the reward system and how it's being activated. And
Nick Jikomes 53:00
is what you alluded to there a moment ago, that like with ozempic, it's the new version of weight loss drugs that we have their GLP one drugs, they're causing people to eat less, but people are also, well, it's kind of interesting the way things are being looked at and reported. Because people are saying, Ah, it might help people with alcoholism and these addictions. And that makes sense to me, if it's tapping into this reward circuitry. But I wonder if they're also just not looking at what we might just call natural health reforms, reward that might also be getting messed with here.
Nicole Avena 53:27
Yeah, I think so. And I think, you know, anything that's going to cut back on your desire, I think that's the key word, you know. It's one thing. If people who use these drugs, you know, don't have an appetite because they're nauseous, right? That's a different type of, okay, appetitive behavior, right? Like nausea, appetite suppression is very different than I have no desire to eat anything that
Nick Jikomes 53:53
I have less than desire to to seek rewards of any kind. Yes, yes.
Nicole Avena 53:57
So I think it's an interesting question. Scientifically, I'm not quite sure that it's been explored, but I know that, yeah, there's a lot of interest in, you know, looking at these GLP one drugs to see, you know, if they can help with alcohol cravings, and they there's been anecdotal reports of that actually happening, where people will say, I don't want to drink anymore because I'm taking this drug, and suddenly I don't have no desire for alcohol.
Nick Jikomes 54:20
And I guess the best case scenario here is it helps people lose weight and it helps people kick these other addictions. I guess the doomsday scenario here is that the drug companies will naturally look for those outcomes first and strongest, and to the extent there are knock on effects where people start getting depressed and having psychiatric issues, we won't probably know until a number of people start having those effects and then reporting them. We're not going to know, because people are going to look for that ahead of
Nicole Avena 54:49
time, right? Exactly, you know, you have to always ask, like, what are the, you know, clinical endpoints that are being measured? And you know, How many friends do you have, or how often do you want? To, you know, be with your partner, or whatever, is perhaps not something that they're assessing. So you're right. I think it's, it'll be some time before we we know this full scope of how those drugs are actually working and what effects they're having,
Nick Jikomes 55:13
is there anything you can say about so, so, you know, within the context of the heightened palatability and the addiction stuff, there's also, you know, superimposed on that the actual metabolic effects. And, you know, cells and tissues throughout the body are there important differences between different forms of sugar that we should talk about, like glucose versus fructose. You mentioned briefly earlier that. You know, fructose is processed primarily in the liver, unlike glucose, and so the metabolic effects in those types of tissues can be very different between the two substances. Is there, you know, with the types of artificial caloric sweeteners that are the most common, things like the high fructose corn syrups and things like that, they have the palatability that's going to drive, you know, the sugar cravings and things like that, are they also having, you know, based on their composition, especially detrimental metabolic effects on top of this sort of addiction component. Yeah.
Nicole Avena 56:07
So I think that the fructose piece is important part to look at, because even though, you know, when we look at sucrose, for example, sucrose is glucose and fructose put together a dimer, and there's a bond holding them together, and that bond is dissolved, and then we get glucose, and we get fructose, and the fructose does its thing, and the glucose does its thing. And then we have some other sweeteners, like you mentioned, high fructose corn syrup, which is similar to sucrose in that it contains glucose and fructose, but it's not proportionate. So Sucrose is 5050, it's it's one sugar because
Nick Jikomes 56:42
they're physically bound one to one, basically
Nicole Avena 56:44
bound one to one. Whereas high fructose corn syrup is not. It's just fructose and glucose put together. And another issue with high fructose corn syrup is that it is often the 55 version is used. So that basically means it's 55% fructose and the rest is glucose. There's other versions of it that are used in baking and confectionery that are up to, you know, high fructose corn syrup, 75 or maybe even higher, where it's 75% fructose and then 25 glucose. And so that basically means you're getting more fructose in your body. But even if we look at just high fructose corn syrup in and of itself, and let's just say, you know, it was 50% fructose and 50% glucose, when that fructose gets in our body, it's metabolized very differently than, like you mentioned about glucose. So the fructose is metabolized by the liver, and what ends up happening over time is that the Isolate cells in the liver, excuse me, the cells in the liver, essentially can have fat that gets stored inside of the liver. And this is directly related to the fructose consumption, excess fructose consumption, I should say. And so our livers ability to basically process all that fructose is impaired, and it ends up getting stored as fat. And, you know, it used to be the case that it was called fatty liver disease, and it was something that you would only see in somebody who was like a 50 year old alcoholic, but now we're seeing non alcoholic fatty liver disease. It was a disease that had to be named and created to deal with this fructose induced situation that we're seeing because kids are experiencing this. There's kids that are developing fatty liver disease, and it's not because they're consuming alcohol, it's because they're consuming all these foods with excess amounts of fructose that get into their body via sucrose or other sweeteners.
Nick Jikomes 58:44
And so even though, even though alcohol and fructose are not the same thing, obviously, you know, at a high level, at least, we can think of them similarly with respect to the liver, because they both have to go through the liver to be, I mean, essentially detoxed, yeah,
Nicole Avena 58:58
exactly. And, you know, I think that it to me, it's, it's concerning, because I like to look at things again. You know, this is a long game that we're playing here in terms of, you know, people aren't going to die from having, you know, one cupcake today, but if we're raising a generation of children on all of this sugar, we're basically walking them into adulthood, perhaps with impaired livers to begin with, from a diet rich in all this fructose,
Nick Jikomes 59:27
and then they start drinking alcohol, and then they start doing adult stuff. Yeah,
Nicole Avena 59:31
are we going to see like people getting cirrhosis of the liver from drinking a couple glasses of wine now and then? So again, it's, I think, important to think about, you know, what are the effects that we're doing when children are younger? Or what are the effects of what our diet is doing to us having on, you know, other aspects of our health that we might, you know, engage later on,
Nick Jikomes 59:56
is there. So when we think about not just the raw. Sugar content, or the high fructose sugar content, but the the full food matrix and the level of work required to consume something, you know, you mentioned, you know, there's, it's a big deal whether or not something has fiber versus no fiber. It's, it's matters whether or not you have to, like, get something and then chew it versus just drink it. You know, when it comes to things like beverages, like sodas, they not only have high sugar content, but it's liquid completely devoid of sugar. Are those types of things some of the worst offenders when it comes to sugar intake?
Nicole Avena 1:00:29
Oh, absolutely. There was a paper that came out of Harvard from Frank Hughes lab a few years ago that showed, really for the first time, that consumption of sugar sweetened beverages and also artificially sweetened beverages, was directly linked to cardiovascular disease and increased mortality, and it was the drinks it's you know, yes, consuming food certainly doesn't help that when it's high in sugar, but the drinking of these beverages really can be detrimental to our health. And there's a couple reasons behind that. One, you know, you can get a large amount of sugar in a small amount of time. You just have to swallow it. You don't have to, you know, sit there and chew it. This is why I'm not a big fan of smoothies, juices. I'm not a big fan of for obvious reasons, because you're taking out all the fiber, you're just basically, like, you know, keeping the sugar, and you're getting rid a lot of the good nutrients. But smoothies are, you know, much, much easier to consume, and that's why, I guess, people are attracted to them, right? Because, you know, yeah, I don't have time to, you know, eat all this berries and vegetables in the morning, so I'm going to put in a smoothie and I'll just drink it. That's great. But when you see people making a smoothie with, you know, four bananas in it, and, you know, three apples and,
Nick Jikomes 1:01:51
you know, tequila sometimes,
Nicole Avena 1:01:53
yeah, you know, you it would take you, you wouldn't even be able to sit there and eat all that fruit, right? Be tired of it. So the thing about beverages is that they are almost like invisible calories. Your body doesn't register the calories in a beverage. Like, if you think about, have you ever drank something like, you know, a can of soda or beverage like that, and been like, Oh, I'm full. But if you have equal number of calories in a solid food, you will be full. So, you know, there's been lots of studies that have compared this and looked at, you know, this difference that we experience when we consume something in liquid form versus solid Yeah, yeah.
Unknown Speaker 1:02:33
And I think, you
Nick Jikomes 1:02:34
know, this is, again, where I think, with the the analogy with drug addiction comes in. And what I mean here is that, you know, the form factor and the rate of absorption are very important for determining the reinforcing value that something has. So, you know, a classic example would be snorted powdered cocaine versus inhaled crack cocaine. They're essentially both the same thing at the end of the day, one of them is going to hit your bloodstream much more quickly and circulate faster than the other, right,
Nicole Avena 1:02:58
exactly. And when you're chewing food, you have to digest it. There's going to be a slow release of, you know, these different components of the food, as your body breaks it down, as your digestive system kicks it in and does what it does to, you know, extract nutrients from the food, whereas that is really sped up when we talk about drinking something. And so the effects that you experience, you know, when people have these sugar sweetened beverages are, you know, very, very different than if they're going to be eating something that contains sugar. And that's part of the reason why, because of that router administration,
Nick Jikomes 1:03:38
how much do you know about the engineering of processed foods and how much conscious engineering goes into that? Well,
Nicole Avena 1:03:47
there's certainly a lot of consciousness that goes into it, because it's a business, and, you know, people want to make sure that they're doing their research to make sure that whatever product they're developing is going to be successful. And I think that, you know, people are, I guess, a bit naive if they think that the food companies care if the food is healthy or not, the that's not their job, to be honest. I mean, their job is to make food and sell it. It's not like it says this is healthy food. They're not claiming it's healthy food. They never said it was. So, you know, why should they have to abide by that rule? So I think that there is a lot that goes into it. Many food companies hire, you know, food scientists that basically their job is to figure out how to make these foods more desirable, how to make them smell a certain way, how to even down to the packaging, like when you open the package, the sound that it makes. Because you have to keep in mind, this is all preconditioning. You know, we come to associate that sound with the eventual taste of the food product. And after those pairings have been made a few times, we very quickly learn. So that that sound is associated with that delicious taste. So it's going to release dopamine just by having the sound. That's why the advertisements and the way in which the packages are, you know, kind of were trade on a shelf. That's also important too, because it serves as a way to kind of prime us to then want to get that substance, because we were called a taste. So there's a lot that goes into it, even beyond what the actual food tastes like, to make these things desirable so that people will continue to buy them.
Nick Jikomes 1:05:32
If someone you know has been consuming a lot of sugar for a long time, and you know, they're effectively addicted to sugar, I would imagine there are adaptations, physiological adaptations, that are going to distinguish them from other people. You know, the level of sweetness receptors in the tongue is probably different. For example, if someone is trying to kick a sugar addiction or something like this, is this possible? How much time does it take? Will there? Does your tongue readapt. Can you sort of stop consuming sugars and then eventually come to enjoy the lesser amount of sweetness you get from eating a physical orange rather than a glass of sunny delayed or something like
Nicole Avena 1:06:10
that? Oh yeah, absolutely. I mean, you know, I wrote a lot about this in my book sugar less, that is out now. It's coming out in paperback in January. And you know, one of the things that I think people are intimidated by is this whole idea of, Oh, I'll never be able to, you know, find joy in food again, right? And I think this happens with people who struggle with alcoholism a lot of times. One of the barriers for them giving up alcohol is that they've become so dependent on alcohol to just help them get through their day, and so they can't imagine life without it. And I think that's something that happens a lot of times when people are kind of struggling with sugar addiction is, you know, I can't imagine being happy or satisfied or feeling good not having sugar. And physiologically, our body completely changes, because when you wean yourself off of the processed food and the added sugar. What ends up happening is that, yes, your taste receptors are going to change. You're also going to see that the connections in your brain, in terms of, you know, the desires and the cravings, are going to become easier and more manageable, because it's, again, all about learning and learning theory, we're putting distance between the stimulus and the reinforcer, and if you're not providing the reinforcer, even when you get the stimulus, over time, the learning is going to break down, and you're not going to, you know, have those strong cravings like you had in the past. So that, I think, is important to keep in mind, it's just a matter of getting there. And people often will say, Well, how long does it take? It really depends on the individual, like, how much sugar they've been consuming and also for how long. I mean, you know, there's a lot of people who have been consuming lots of added sugar for a very long time, so it can take a while in cases like that. But what I really advocate is that people do not a cold turkey approach. Because I don't think that that really works. I know people typically, when we talk about addiction, think, Oh, well, you know, if someone's addicted to cocaine, you don't say, Oh, just do a little less cocaine. You say, No, you gotta stop doing all cocaine and just get off of it.
Nick Jikomes 1:08:17
But the cocaine isn't in everything. The cocaine isn't in everything,
Nicole Avena 1:08:20
yeah, and you know, there's, like, it's pretty clear, like, cocaine is cocaine. I know where I'm getting it, but, you know, there's like, shades of gray with lots of these different foods that are out there where, you know, maybe it's got a little sugar in it, but that's okay if I'm not having tons of sugar from other things that I'm eating. So I think it's important to do more of a step wise approach and focus on beverages. I think that should be the number one goal, right off the bat, is to reduce the amount of sugar and beverages that people are consuming, and then kind of go from there and just work to reduce it and reduce it and have less and less of it and that that again, you know, it's going to have effects that are going to be positive for people's health, no matter what, even by just reducing it little bits at a time.
Nick Jikomes 1:09:09
I, you know, I think at this point, in my personal view, anyone who's paying attention understands that our food environment is engineered and it's it's basically toxic, and it's filled with lots of garbage, and people will argue details, and some people will blame the sugar more, or the seed oils more, or the food dies. You know this that there's all sorts of stuff we could talk about, but this is the food environment we're in. To what extent do you think changes can be made to the food environment, versus, to what extent do you think it's really just going to be up to people to regulate their relationship with this environment? Because, you know, it's not, certainly not going to go away entirely anytime soon.
Nicole Avena 1:09:51
Yeah, you know, it's a difficult question, because it kind of goes back to how I got interested in this, you know, like the. Issue back in the year 2000 2001 was obesity, and well, is it just up to people to just say no to food and not eat in excess, and that's that's going to be the cure for obesity? And kind of, again, going back to the initial query I had, which was, well, what if the food's addictive? When it's addictive and people lose control, and they don't really have that rational aspect to their decision making, like people would if they weren't
Nick Jikomes 1:10:28
addicted. Yeah. I mean, by definition, addiction is a diminishment in willpower, exactly,
Nicole Avena 1:10:33
exactly. And so I think, yes, I think it's going to take people to stand up and say, You know what, we're demanding that these foods, we're not going to buy them, right, right? That certainly would be one way to deal with it. But if then, on the other side, we're saying, Okay, well, these foods are addictive. You know, it's it's not going to be quite so easy. Yeah. Can
Nick Jikomes 1:10:58
you do that enough to actually move the needle? Yeah? And I
Nicole Avena 1:11:01
think that, you know, a lot of fortunately and unfortunately, but fortunately, a lot of the people who have been speaking out about this, and the people who can really make a change are going to be the people who aren't struggling with food addiction, or who aren't struggling who who kind of are able to then say, You know what, we're just not going to buy that stuff, and hopefully we can get more people to to fall on that side of the fence, so that, you know, then these products just won't be demanded by consumers. But again, I think, you know, it's a little bit short sighted, because most people in this country are obese or overweight, and it's most likely related to their access to food, and they're more likely to be consuming food if they're living in a food desert that's going to be highly processed foods, because that's all that's available to them. So I think, you know, it's a complicated issue, but I do think that you know, it's going to have to come from people to kind of speak up and to demand some changes, but I also think that we need to, at some point, have some regulations in place. I mean, you can put as much sugar as you want. I mean, there's nothing, as long as it's on the grass list. So generally recognized as safe ingredients, you can put whatever you want together and concoct any type of food product that you like, and no one can tell you not to, as long as the ingredients are safe. But there's no limits on, you know, how much sugar, you know, how much dye, all these other things that are coming up as you know, refining to be detrimental to health. There's a license by the food companies that basically just do whatever they want. And I think that that needs to change.
Nick Jikomes 1:12:43
And I really don't know a whole lot about this, but that generally recognized as safe designation. Where does that come from? And how is it set? Because I've heard this before, but I've never really looked into it. It sounds like you shouldn't. You know, generally recognized as safe. There's a really low bar there, oh
Nicole Avena 1:13:01
yeah, and it's, you're basically innocent till proven guilty, right? So, and I have to see if this is the case for the food industry, but I know for the dietary supplement industry, it's the case where companies can now, like, self proclaim ingredients as being grass, so create something in there by default. Yeah, and it's grass. It's fine until like something bad happens and they realize, oh, wait, never mind. It's not. It hasn't
Nick Jikomes 1:13:30
been recognized as toxic yet. Yes,
Nicole Avena 1:13:33
you know it's interesting, if you look at what's happening in the UK. So the United Kingdom has much more stringent procedures in place when it comes to what can and can't be in their food many products that are generally recognized as safe here are not allowed in the food companies to be produced and sold in the UK. And so I think, you know, I know that we're like on different parts of the world and in different spaces in the planet, but we're still humans, and there's no reason to think that, you know what's not safe for them is going to be safe for us, right? So again, it's complicated, but I do think there could be more done there to tighten that up, because it is a bit of the wild wild west when it comes to what goes in these things.
Nick Jikomes 1:14:21
What, what are you working on in the lab these days as it relates to any of this stuff? What are, what are some of the outstanding questions when it comes to things like sugar, either on the addiction side or the metabolic health side?
Nicole Avena 1:14:32
Yeah, great question. So I've become a lot more interested in sort of the genesis of sugar addiction. And, you know, I think this is kind of come out of interest in early life nutrition, so the first 1000 days, so looking at what's consumed during pregnancy up to age two years of after birth. And, you know, kind of seeing how that relates to. To health outcomes later in life, mental health and physical health. And there's been a lot of work that's been looking at the role of that early life nutrition window, and comes really to immune system health outcomes related to cognitive abilities, and also outcomes just related to various different medical complications. So that's where I've been, kind of thinking and focusing these days, is this sort of early life component, and also, you know, just still trying to better understand and it's getting a little bit more complicated as our our food environment, is getting so much more complex, like as time goes on. I mean, there's new ingredients popping up all the time. There's new sweeteners that are, you know, are appearing. And it's almost like these things are appearing and being widely used before we have had a chance to sit down and, like, assess, like, okay, is this good for us to use? And our little long term effects, and what happens when you combine these things? That's the other thing. I mean, if you look at a lot of the different products that are out there, to get around the requirement now where food companies have to disclose the amount of added sugar you're seeing. Not only is there added sugar in products because they have to declare that on the label in terms of how many grams of added sugar, but they're also to keep that number lower, just because people don't like to see that number that high. There's like, other artificial sweeteners that are added. There's other non nutritive sweeteners that are added. So there could be four or five different types of sweetener in one product
Nick Jikomes 1:16:36
now, and it looks like it's with with low added sugar,
Nicole Avena 1:16:39
right? But it's just that, you know, it's, it's probably, actually, I when that first came to be that the companies were required to disclose that, I think everyone thought that was going to be great, because that would mean that companies would have to reduce how sweet the products were. But I think it backfired. If anything, the products are more sweet now because they're adding just all these different alternative sweeteners to the mix as well, in addition to added sugar. And then you
Nick Jikomes 1:17:05
mentioned your book earlier. Do you want to mention that again and just kind of point people to where they can read more about your work in general?
Nicole Avena 1:17:12
Oh yeah, absolutely. So my new book sugarless is about the research on sugar addiction, really kind of the history of it, and really is great for anyone who's just interested in learning more about sugar and how it affects not only your physical health, but also mental health, and kind of just understanding this landscape of our food environment and how sugar fits into that. And also, if you're struggling with cutting back on it, or want to cut back on it, how you can basically use what we know from the science to help to reduce your dependence on sugar. And you can get that anywhere books are sold, Barnes and Nobles, Amazon, all the regular places. And if you want to learn more about the work that we're doing, you can check out my website. It's Doctor Nicole avina.com and you can also find me on social at Dr Nicole Avina and
Nick Jikomes 1:18:04
just, you know, one final question, I guess. How you know, what kind of high heuristics do you use to regulate your own exposure to sweetness? Are you just trying to minimize added sugars and artificially sweetened foods of any kind? Are you moderating at all your consumption of whole fruits. Or, like, where do you sort of regulate yourself?
Nicole Avena 1:18:24
Yeah, so I I don't moderate my consumption of whole fruits. I think it's because I really don't eat much added sugar. And what I do, like, for example, for breakfast, I had a couple slices of an apple, and I that I was satisfied. It got to be too sweet for me because, you know, I don't eat much sugar. So for somebody like me, having just a couple slices of Apple is going to satisfy whatever, you know, tolerability I have for sweetness, it started to become aversive. But somebody who is eating, you know, Cheerios and all these other things that have lots of added sugar in them. You know, they're probably not going to find that Apple to be, you know, super sweet, so they can eat a lot of it. I don't think that the problems we have right now, in terms of the poor health in the United States and many other countries, are related to people eating too much fruit. I really think that's the least of our problems. But I do think that, you know, again, it just leads to this excess consumption of everything that comes from this background of all this ultra processed food with added sugar in it. So, yeah, I don't really. I just try my best to not eat processed food and to not eat, you know, stuff that has a lot of added sugar. But hey, if I want to have cookies and we're baking cookies, I'll bake cookies. But I just think that, you know, it's, it's for me, I just, I know too much, and so I have to do this. But you know, it takes effort. It takes time to prepare food and to, you know, cook a. Lot of things, but I enjoy doing that. And I think that, you know, for me, that's just what I like to do, and I think that's my way of protecting my health. And I think, you know, if more people got on board with kind of slowing down and and just taking the time to prepare stuff yourself so that you know what's actually in it. It really matters now, because even we're hearing a lot about all these food recalls and bacteria, blisteria breakouts and things like that. So I think that you know, keeping it closer to home is the best way, because you don't know what's in it, and you have more control. If you do want to make cookies and add sugar, you get to control how much sugar you add, so you don't have that option when you buy them in the grocery store.
Nick Jikomes 1:20:45
All right. Dr Nicole Avena, thank you very much for your time.
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