Breaking Free from Sugar Addiction: A Journey to Health with Dr. Nicole Avena

Bettina M Brown: 0:06

Hello and welcome to In the Rising: A Health and Wellness podcast for those going through and those supporting those going through cancer. My name is Bettina Brown and I'm board certified in physical therapy, wound care and lymphedema. And you know, for me cancer is very personal. It's affected my friends, my immediate and my not-so-immediate family, and therefore, I created this podcast and FitafterBreastCancer.com to address the multiple dimensions of our lives during and after recovery. Hello, hello and welcome to In the Rising podcast Today. I'm really excited to introduce to you Dr Nicole Avena, food sugar addiction expert, because she has a PhD in it from Princeton and has spent over 20 years looking into this, helping us learn how to navigate our nutrition. Nutrition and how really nutrition is medicine. So I'm really excited for you to listen today. Good morning, Dr. Nicole Avena. How are you doing today?

Dr. Nicole Avena:

I am great, it's nice to be with you, thank you.

Bettina M Brown

Likewise, I've read about you. I've read your new book, Sugarless, and what I'm really fascinated about you is that this is a topic that is a part of your life. This is a huge journey for you. Can you share a little bit about your background?

Dr. Nicole Avena: 1:37

Yeah. So it's interesting, I came into this field in a very, I guess, sort of unique way. I've never, luckily, had any issues with eating disorder or my health related to diet. I actually came into this because I was starting my PhD at Princeton in neuroscience and I was talking with my advisor about what kind of project I might work on for my dissertation, which is this huge, massive, five-year-long project. And one of the things that we started talking about and this is going back to the year 2000, 2001, was that at the time a lot of people were struggling with obesity and we were hearing more about it in the media. But the idea was that it's their fault, it's a moral failing, they don't have willpower. And we started to think well, maybe there's something more to this. Maybe the highly processed foods that have tons of added sugar that are really just everywhere these days are doing something to people and it's maybe making them addicted. And just like people get addicted to drugs or alcohol, maybe some people could get addicted to sugar and that could be why it's so hard for people to eat healthy. And so that kind of led me down this journey that I've been on ever since of studying whether or not sugar could be addictive, and from there I have been studying how sugar affects our overall health, how it affects our mental health, and what we've learned has just been fascinating, and there's just so much research now that's been published on this topic and it's just something that's really been near and dear to my heart.

Bettina M Brown: 3:19

Well, thank you for sharing that. And when I was reading about you, you were talking about your graduate work on rats and there was this one line and you said rats and mice have similar neural circuitry to humans and I laughed out like literally laughed out loud because I thought, wow, this is a эта Sad and good at the same time. But what you also mentioned is that the rats also developed some, some tendencies that I felt Connected to, and I don't have the word out in front of me, but there was a resistance to extinction, like when the light bulb was out, sugar was not available, but they still went to it. Can you share a little bit more about what you've noticed about that sort of mental habit?

Dr. Nicole Avena: 4:06

Yes, and I think that you know these studies that we, you know, initially conducted in our little lab rats. In many ways, you know, it reminds me of what happens to humans. And so in our lab rats what we found is that if they're used to pressing a lever to get sugar right, then all of a sudden one day the lever doesn't work, the light bulb isn't on. That signals the sugars available. Their resistance to extinction emerges in the sense that they're not going to extinguish that response. They're not going to just rationally stop pressing the lever right. If you know that there is, you know, no sugar available, the lights not on, the bar is not going to give you anything to drink, then there's no sense in pressing the lever. But what ends up happening? If you're really craving something, then they're going to keep on pressing that lever. And that's what we see in our laboratory rats and we also see that in our people when you think about it. I mean, if you know there's no Dessert in your refrigerator, but you just open it up anyway and stare off into it, and you know. It's again something that I think we can see happening on the human level in many cases where people are craving sugar and it really does, I think, speak to how Powerful those cravings can be and why it can be difficult for a lot of people to not give into them when they do occur.

Bettina M Brown: 5:27

Yeah, and you also describe in the book that we kind of gave ourselves some of this problem by trying to eliminate another problem, trying to eliminate fats. Can you share a little bit like how did we end up here?

Dr. Nicole Avena: 5:42

Yeah. So I think this is really interesting because it's kind of part of the social history of Our food environment, which I think is really just fascinating because there's so much psychology in it. So what really happened for those that can remember back during this time, who were alive, you know, back in you know the 1980s and 90s, we really started to see this big push toward Minimizing fat and there was this very big media push and medical community push to reduce fat in your diet, because fat had been linked to cardiovascular disease and so fat became demonized. And I remember being a kid, and you know my mom Would try to be healthy, so she would go to the store and buy these cookies that were fat-free cookies, and it was literally like a license to be able to eat as many as you want because they were fat-free, so they're good for you. The problem was that when you take the fat out of food products, you don't really have much flavor, and so in order to make them taste good, you got to put some sugar in. So all these fat-free products were loaded with sugar and other carbohydrates and so, although we were good about getting away from fat, we inadvertently ended up getting hooked on sugar as a society. And so now what we're seeing is the effects of that in terms of, you know, rising obesity rates obesity, you know, being so pervasive across the country and Also all of these medical complications that can come along with eating too much added sugar. You know, it's not just overweight or being obese, it's cardiovascular disease, it's diabetes, it's fatty liver disease and, on top of that, it's also mental health issues that can arise as a result of too much sugar. So it did start off by, like you said, you know, trying to fix something that was a rye where, you know, yeah, fat wasn't good for our heart, but in the end, I think we often really do more damage than we did help, because it's something that we basically just replaced, you know, one bad thing with another.

Bettina M Brown: 7:55

Absolutely, and I think, ultimately, the quest is always to find this health. But everything has a variety for a reason. I think that's what we're coming about and, as I've done some of my own research, our addiction makes people money. Also, there's food companies that literally will Take chips and Find out what is the right amount of crisp that makes us have a little dopamine hit right. So we are creating, we are our attention, our food choices are really Benefiting some people. So I think some people are motivated by wanting to be healthy, some people are motivated by anger and some people are more by fear. So Whatever it takes to really change that. You also shared this one thing that rats preferred the sugar over cocaine, and I think that's something to to really take a moment and pause about. Can you describe that?

Dr. Nicole Avena: 8:54

Yes, I think this is one of the more popular studies that's been discussed, because it is really, I think, alarming when you think about it. And so, in this study, rats were offered a choice between sugar, water or cocaine, and they overwhelmingly decided that they would rather have sugar. And so, again, you know, we know that cocaine is a very powerful addictive drug, and the fact that rats are willing to consume sugar in place of it to me is really telling in terms of how powerful sugar is and how it can affect the brain. And I think that it is interesting too from the standpoint of, you know, we all know that cocaine's not good for you and you shouldn't use it, but in our modern society, I mean, we really do not discourage sugar use. It's celebrated. I have little kids, and so I see this in the schools all the time, where you know everybody gets a lollipop or everyone's getting candy, or you know it's something that's really heavily promoted, especially among young people, as you know, being a socially acceptable, normal thing. And I think that that makes this all the more dangerous because what we're finding that's happening is that, over time, yeah, kids might, you know, be healthy when they're young, but if we're in training them to be addicted to sugar when they're five or six years old, then what's that gonna mean for their health when they get older and those habits are gonna be really difficult to break.

Bettina M Brown: 10:30

Absolutely, and thanks for pointing that out about how we're training. You know our kiddos and I will share that my I'm a mom as well and when my son was young, I would try to take the lollipop and say, let's save that for another time, let's have some carrots or this. And I remember this one time that he just said I want sugar, and it made me pause. I literally stopped moving and I thought, wow, this is this process already unfolding, because that's what they get a snacks at school and a reward.

Dr. Nicole Avena: 11:04

Yes, and I think that's something that, over time, we just need to change. I think, you know, 50 years ago it was fine, you know, for the teacher to give out candy because that might be the only sweet thing that the kid had all day, but now, I mean, it's just one of the you know 99 sweet treats the kids are having throughout the day. So I think it's really something that we need to revisit in terms of rewarding our kids for their good behavior. And, you know, we have to keep in mind, if we know that this is bad for their health, it's not a reward, If anything, it's a punishment. And so we need to just, I think you know, make some changes around that socially so that we can, you know, help our kids to get on a good track for good health as they get older.

Bettina M Brown: 12:01

Absolutely. And, Dr Avina, you've mentioned a few times sugar and mental health. Can you expand on that a little bit?

Dr. Nicole Avena: 12:08

You know, this is one of the things that I found to be surprising. I wasn't really expecting this to be one of the outcomes of cutting back on added sugar, but, overwhelmingly, when people that I work with or talk with who have been able to reduce the amount of sugar in their diet and get away from it, will report that they're surprised at how it affected their mood and how it made them feel so much better and how they felt clarity of thought, how they didn't have that brain fog anymore. And I think, from the biological standpoint, it comes down to the fact that sugar is highly inflammatory and when people are consuming it in excess, it's gonna have an inflammatory response, and that can happen in our brain. And so when we're able to remove sugar and reduce it, it really does help our brain to heal and, as a result, we're going to see things like you know improved mood. We're gonna see things like you know, not having achy joints all the time and we're gonna see, you know, these other unexpected but yet pleasant consequences of cutting back on the added sugar. And I think for the mental health piece especially. I mean we hear so much about mental health these days and how many people are struggling with mental health issues, and I think for all of us, it's in our best interest to look at our diet when we think about our mental health, because that's something that you can easily change, and if it's gonna improve your mood and help you feel better, then why not? It's something that I think we all could benefit from.

Bettina M Brown: 13:46

Yes, yes, and you know, with lots of inflammation come along other issues, like you even mentioned the joints. What about this other topic? And then we're gonna go into the second part of your book about obesity and sugar. I feel like there are sometimes, just when I look at it as a regular person, like well, can I have some sugar? Can I not have some sugar? Are they hiding sugar in other places? And then is this going to make me fat?

Dr. Nicole Avena: 14:18

Yeah, I think that it boils down to your relationship with sugar and whether or not you're in control, and I think that's really the goal of my book sugar list is to help people to get the control back, because for many people who are addicted to sugar, the sugar is in control right. The sugar is telling them I want you to eat more of me, I want you're going to have withdrawal, you're going to have to crave me, and that's not how it's supposed to be. And so it's really about getting to the point where you can enjoy sweet treats and be able to say, okay, I've had enough, I've had one piece and that's all I need to feel good or to enjoy myself. And so it's not about really just completely cutting everything out. I don't think that's sustainable, I don't think it's possible and I don't think it's necessary. I think it's more about getting control back, and I think, when it comes to our diet and obesity, I think for many people, yes, that is something that they're concerned about. If people are trying to lose weight or want to have a healthy body weight, cutting out sugar can be one of the easiest ways to do that to reduce your body weight, and starting with beverages, I think, is really the spot to start, because a lot of our beverages are loaded with added sugar, and it's not just sodas and juices, which we should avoid, because those are really just empty calories and loaded with added sugars that are going to provide nothing but excess body weight to us. It's even the coffee drinks. This has become. One of the things that I've been noticing a lot more and more is that you go to a coffee shop these days and basically it's a dessert. I don't even know if it's coffee anymore. It's so much sugar in it. I think there's more sugar than there is coffee in the products. So it's really about, I think, just revising your relationship with sugar and making sure that you're in control, and that's what I walk people through in the book with the different seven step plan that I offer for people to just get control back.

Bettina M Brown: 16:18

Absolutely, and it's sugarless a seven step plan to uncover hidden sugars and curb your cravings and conquer your addiction, and one of your steps is to do a three day food diary to actually know what you're eating. From many people that I've had a conversation with, this is almost like the most difficult part is to really do this food diary. Do you feel that it's kind of hard to face what you're eating because it's three days of just writing some things down, or do we have shame with what we're eating?

Dr. Nicole Avena: 16:51

Well, I really try to encourage people, when they do this important step, to not feel shamed, not to reflect on themselves like oh my gosh, I can't believe I'm eating all this stuff, or look at these twins. It's about getting a realistic picture of what you're actually eating on a day to day basis, and I think for a lot of us, you don't realize it until you put it down and writing and are able to see how little bits of sugar here and there become sugar everywhere. And when you add it up and you see how okay, the coffee that you had with breakfast that you put creamer in, and the yogurt that actually had a lot of sugar in it, and then the pancakes with the syrup that actually had a lot of sugar in it, by the time you even leave the house in the morning, most people have had well over the recommended amount of added sugar in their diet already, and so when you put it down on paper, I think it can really just be a good exercise so that you can take a look and understand okay, this is what's happening, this is what I'm presently doing and how can I now make some changes to this to better my health. And it's not about cutting all the sugar. Like I said, it's about reducing the sugar, it's about making swaps. So maybe instead of having the creamer in your coffee, maybe you have just a splash of the creamer, or maybe you decide, you know what, I don't need the creamer, I'm just going to have plain milk, or, you know what, maybe I'll just have it black. Making these small changes and sticking with them and then over time it's going to add up and that's really the focus of the book and one of the goals that I have is to really just help people kind of get on that journey.

Bettina M Brown: 18:32

And then you said you've also worked with people going through things. Is that where these like seven steps came from, like as you're seeing people trying to navigate their sugar consumption?

Dr. Nicole Avena: 18:47

Yes, and you know, one of the things I've noticed over the years, for most people who try to do this on their own, is that it is overwhelming, and, you know, a lot of times people feel like they're failing before they've even started it, just because they don't know where to begin. And so that's why I found that, you know, outlining these seven steps was really just crucial for people, because it enables people to have a place to start, and one of the things that I think unique about the plan is that the steps are not linear, meaning that you know, once you finish the first step, you're on to the second step, you can go back to the first step, and that's, I think, the beauty of you know this plan is that it's meant to be something that you can do for your entire journey, for the rest of your life. It's not a diet book where you're going to, just, you know, do this for six weeks so you can lose 10 pounds, or whatever the goal is. This is about reevaluating your relationship with food, and it's something that, if you want to make these changes that are going to benefit your health, it's got to be a commitment that you're going to stick to, and so that's where I think the steps can be really helpful, because it keeps people aligned and it helps people to attack this bit by bit and so it's not so overwhelming.

Bettina M Brown: 20:08

Thank you for sharing that. I have one last question for you, because I hear this often from my own patients, where they hear things like yes, sugar is addicting, and we hear from other drugs. You know it takes one time and you can form neuro pathways and you're addicted. How long will it take to become unaddicted to sugar if this is really where you've been raised with the fat-free cookies and here we are today, or is that just a change for the rest of your life that you have to do?

Dr. Nicole Avena: 20:46

Well, you know, I think the thing about sugar is that we which is unlike all the other things that we get addicted to we are biologically programmed to want sugar. From an evolutionary standpoint, sugar has been coded as being safe, and sweet things are usually good for us. So if you think about our hunter and gatherer ancestors, if they stumbled upon a berry, bush, the berries that are ripe and healthy are going to be the sweet ones, so those are the ones you want to eat, but the berries that are sour, that are rotten, are going to be on the floor of the forest and you don't want to eat those. Even breast milk, if you think about it. You know baby's first food is sweet. Breast milk has sweetness to it, and baby formula obviously has sweetness to it, and so, typically, you know, sugar is safe from an evolutionary standpoint, but the problem is that our brains have not caught up with our present food environment, and now sugar is everywhere and it's added to so many things. We have so many man-made processed foods that are not good for us. Just because it's sweet doesn't mean it's safe anymore, and I think that's the problem that we all struggle with in terms of breaking this addiction, because we're all at risk because of this inherent biological drive to have sweetness. So I think, in terms of how long is it going to last? In terms of breaking the addiction, I think that for most people, what they find is that, you know, once they're able to work through the seven steps and really just get a better handle on their diet and have the tools in place, it's something that they can easily sustain. But I think that all of us are still at risk always, and that's why we need to be cognizant and mindful that you know we can fall back into this trap of binging and craving and withdrawal, and we just need to be aware, you know that sugar is out there and we got to make sure that we're staying in control of it and we can't get back to the point where it's controlling us.

Bettina M Brown: 22:51

As a physical therapist for quite a few moons now, I have just decided to take the opinion that your body is your gift, and how you choose to nourish it and use it so far as hiking, biking, walking, having a good time with friends what you choose to do with that really is a reflection of what you value. It is also a reflection of what we know and the information keeps changing and it is our responsibility to take care of this gift, because one thing I do see is when we don't have the full use of that gift, it really affects our life deeply, and so I encourage you to learn and make your own opinion, make your own informed opinion, knowing half of what you're dealing with is your own biology, right. So I thank you so much for listening to this. Go ahead and email me. If you have any ideas or you would like to further this discussion at Bettina at intherisingcom, go ahead, hit subscribe. It does so much for this channel and please leave a review. I thank you for your time and let's keep building one another up.

Dr. Nicole Avena: 26:20

You, you, you, you the you, you, the, you, you you.