Shireen: Podcasting from Dallas, Texas. I am Shireen, and this is a Yumlish podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type 2 diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

Shireen: Dr. Nicole Avena talks to us about sugar and food addiction. What it really means, the brain reward system, if being hangry is real, and the relation between food and mood. Stay tuned.

 Dr. Nicole Avena is an associate professor of neuroscience at Mount Sinai School of Medicine in New York City, and a visiting professor of health psychology at Princeton University. In addition to over 100 peer reviewed scholarly publications, Dr. Avena has written several books including What to Eat When You’re Pregnant, What to Feed Your Baby and Toddler, and What to Eat When you Want to Get Pregnant.

Welcome, Dr. Avena.

Dr. Avena: Oh, thanks so much. Happy to be here.

Shireen: An absolute pleasure having you on. So, Dr. Avena diving right in. What intrigued you about specifically food addiction that made you want to be really a pioneer in this field?

Dr. Avena: Oh, well, well thank you for the kind words. You know, it’s interesting, I got into this whole field kind of serendipitously.

I was a graduate student at Princeton University. I was doing my PhD in neuroscience, and I had literally just started, it was like day one. And I was speaking with my advisor about what kinds of things I might work on for my dissertation project, which is this huge five year long project that you work on.

And one of the things that we started talking about was how back at this time, and this is going back to the year 2001, a lot of the mindset around obesity was still that it was the person’s fault who was obese. And it was because they had some moral failing and couldn’t regulate their own food intake.

And I started to kind of think that that was a little bit off because we were seeing the number of people with obesity going up. We were also seeing that our food supply was changing in the sense that we were becoming more heavily reliant on processed foods and a lot of those foods had added sugar.

So, we started toying with this idea about, well, maybe if the food is what’s causing obesity. Maybe it’s not the person, but maybe there’s something about the foods that people are eating that are causing them to feel compelled to overeat. And if you took a look at any magazine or any articles that were out there at that particular time, and even to this day, people will talk about how, yeah, of course I want to lose weight, I want to get healthy, but it’s really hard because I feel compelled to eat these foods. I have cravings.

And so that kind of set us down this path of trying to investigate from an empirical standpoint, from a research standpoint, could food be addictive? And at the time it was a bit of a challenge because nobody was studying this. I mean, we were kind of, I think the culture knew that, yeah, we were drawn to eat sugar, we’re drawn to eat sweets, like people liked those foods.

But there wasn’t any scientific research out there specifically looking at food addiction until we kind of came on the scene back then.

Shireen: That is so interesting. And with food addiction I want to talk a little bit about sugar addiction. Now. and this goes back to what you talked about that sort of feeling that failure and sort of demonizing this individual and their choices and all of that. And now just getting into sugar addiction first, can you define what it even is?

Dr. Avena: Well, so sugar addiction is this idea that people can become addicted to sugars, added sugars. In a way that people can become addicted to things like drugs or alcohol or smoking cigarettes.

And so, what we’ve done to characterize this from a research standpoint is to basically take the criteria that are put forth by the American Psychiatric Association to diagnose someone as having a substance use disorder. And these are the criteria that would be used to help somebody decide whether or not they have an addiction to alcohol or any other drug.

And what we’ve done is people can meet those criteria when it comes to sugar. And so, what you see is things you would particularly expect, like within the context of addiction. So binging, development of tolerance, sometimes withdrawal symptoms emerging, spending an excessive amount of time wanting to procure the substance or thinking about the substance, wanting to give up or limit your intake, but finding that it’s not possible to do that. So many different criteria that are out there for diagnosing substance use disorder can very easily be applied to looking at people’s behavior around food.

And so that’s what we’ve been doing to characterize whether or not sugar can be addictive and what we’ve shown in our research and what others have shown in other studies. Essentially that sugar is addictive. It meets all the criteria that the American Psychiatric Association and other bodies put out there in terms of what we consider to be an addictive substance.

Shireen: Can you help differentiate sugar addiction from like someone having a sweet tooth?

Dr. Avena: Yeah, I think that it’s a great question because we are biologically designed to like sweet things. So, we are born with this primitive desire to find sweet things, to be desirable. And this has an evolutionary advantage because if you think about our ancestors, we evolved from people who were hunters and gatherers.

You used to have to walk for miles in the forest and look for a berry bush and we developed this preference for sweet fruits because those are the ones that are safe to eat. So sweet has been coded with safety. You wouldn’t want to eat the fruits that taste sour because those are the ones that are maybe rotten that have fallen to the forest floor and could give you some sort of food poisoning and potentially kill you.

So, you want to avoid those things, but you usually find that things that taste sweet in nature are actually good for you. Same with breast milk. If you think about it, the very first thing that human babies consume is breast milk, right? Or for baby formula. And that tastes sweet. And so, we’ve developed this over the course of generations this mental coating of sweetness with safety.

And therefore, we’re designed to like the sweet stuff. Now, the difference between somebody having a sweet tooth where they like cook cake and cookies and want to indulge. To me it’s about the ability to put on the breaks and have restraint. And I think that is a very personal thing to determine.

If someone feels that they can’t control their intake in the sense that I’m only, if they tell themselves I’m only going to have, let’s say one cookie and then suddenly they’re having seven, then that’s an example of not being able to enact that restraint that one would have.

If it’s just a sweet tooth and you just got to have a little taste of it to kind of address that desire, then that’s fine. But I think the loss of control is really, for me, the hallmark and also the negative consequences that can often come with that. Now, a lot of times this part of the conversation gets a little tricky because sometimes the negative consequences aren’t always apparent.

So, like for example, if somebody is overdoing alcohol, let’s say they’re drinking too much alcohol, they might get a DWI or they might go to the doctor and the doctor will say, you know what you meet the criteria for having alcoholism. Or they might have some medical problem that’s a result of using too much alcohol. So that can be the negative consequence that can emerge. But with food, it could be a little bit tricky because sugar addiction in particular, although we tend to see that people who have obesity and also who are living with binge eating disorder, comorbid, binge eating, and obesity tend to have higher rates of having a food addiction.

That doesn’t mean that people who are of average weight can’t have a food addiction or sugar addiction as well. So sometimes the negative consequences aren’t always so apparent, and I think that this is important to consider.

A lot of times people I think, will kind of use that as a way to kind of put off the problem and they’ll say, oh, I know I’m overeating sugar and I know I’m doing more than I should and I want to stop, but I’m normal weight. My blood works fine. So, what’s the big deal? There’s no problem.

But the problem is that flash forward in five years and you have maybe type two diabetes, or you have high blood pressure, or you have all these other chronic health conditions that kind of creep up on people. You don’t just get them overnight.

They literally like build up in your body over time. Then that’s a negative consequence, and then it’s not that it, it’s not too late. It’s never too late, but you’re wishing you had gone back and addressed the issue when you first noticed it.

Shireen: And I like how you also mentioned that it doesn’t always show up in weight, right? Like that’s differentiated from it. The next question for you is really around if you can help elaborate on this brain reward system regarding sugar. Help us understand that a little.

Dr. Avena: Yeah. So, one of the things that we’ve noticed about the brain as it relates to sugar, is that it’s very similar to the brain as it relates to drugs of abuse.

And so, we have this primitive brain system that’s deep within our brain that was designed to encourage us to eat foods, excuse me, to do things that are going to be rewarding, things that we need to repeat, so it’s our reward system. So, we need to mate to survive, we need to eat to survive, we need to engage in bonded behaviors to survive as a species, and so it makes sense that these things are rewarding and that they feel good, so we’re reinforced to do them.

Now, one of the things about drugs of abuse is that they can hijack that primitive brain system, so they set it into overdrive. That’s why it’s so easy to get hooked on heroin, hooked on cocaine, hooked on alcohol, and many of these other substances because they can set that reward system into overdrive.

Now what we’ve discovered is that food is pleasurable because it provides us with nourishment, but sugar is on another level. What we’ve seen in our research studies is that when you look at the brain, the effect that sugar has is more like what you’d see with a drug and less like what you’d see with just regular old food.

And so, when you think about our modern food environment and the amount of sugar that’s in it, the amount of sugar that we’re consuming every single day, often unbeknownst to us because it’s hidden in so many different foods that we eat. It’s really setting our brains up to become addicted to it. And that’s what I think is happening for many, many people who are really struggling to control their intake and as a result, struggling with many of these diet related health conditions.

Shireen: You know, speaking of sugars, there’s this whole world of artificial sweeteners. Are they healthier? Is there a correlation with sugar addiction and maybe substituting out with artificial sweeteners? Is it a better choice?

Dr. Avena: Great question, and people often will ask me about this. My take on artificial sweeteners and non-nutritive sweeteners is that they can be a band aid.

And so, someone who’s really struggling with sugar and has a lot of sugar in their diet sometimes can phase some artificial sweeteners or some of these non-nutritious sweeteners into their diet in place of sugar, and that can be helpful as a way to kind of jumpstart the change in their behavior.

But it can’t end there because the reason is that many of these sugars are affecting our brain like a drug as we talked about, and the same thing’s happening with these artificial sweeteners. They’re still going to activate your brain release neurochemicals, like dopamine in the way that a drug would.

It’s the sweet taste. It’s not necessarily that it’s sugar from sugar cane as opposed to stevia. And so, I think it’s important for people to realize that they can be a crutch, but it really can’t end there. The goal should be to try to reduce the sweetness in your diet as much as you possibly can and get to the point.

You’re sweetening your diet with fruits. I mean to me fruits should essentially be the source of sweetness in your diet. If you’re craving something that tastes sweet mash up some strawberries and blueberries and swirl into your yogurt in the morning. That really should be the goal is to try to reduce our reliance on sugar and artificial sweeteners. And start to go back to nature’s sweet foods as a way to satisfy our sweet tooth.

Shireen: Dr. Avena, you mentioned that sugar is hidden in so many of our foods. Is it possible to completely eliminate sugar cravings?

Dr. Avena: I don’t think it is, and I don’t think we’re not designed that way. I think that the way our brains are designed is for us to crave sweet things and for us to be drawn toward them.

And I think in a perfect world, which obviously doesn’t exist, that would be fine because if we had a craving for sweet, we could go toward fruits and berries and things that are naturally sweet and that would satisfy it.

 The problem is that we have developed into a society that has been raised on so much added sugar that if you offer, I have little kids at home, if I offer my seven-year-old a strawberry and tell her, here’s something sweet, she’ll eat I because she loves strawberries and fruits. But if I said, oh, here’s a strawberry or a piece of chocolate, she’s going to pick the piece of chocolate. Right? And so, we’ve become somewhat desensitized to some degree. To the sweetness that you can get from fruits because we’re so used to getting all of this sugar from other things, cereals, all these packaged goods that contain added sugars.

And so, I think one of the things I really find to be just so enlightening is when I work with people who are trying to change their diet and get the sugar out. I often will hear when people are able to cut out a lot of the added sugar. They come back and they say, I had no idea how sweet and delicious some of these fruits could be, and how satisfying they could be, because I was just so conditioned to having things that were so loaded with added sugar.

And a lot of times too, when people get the sugar out of their diet reduce it as much as they can, they find that it’s aversive. They find that if they eat. Breakfast cereal that has sugar in it, it’s almost like too sweet. And so, your taste buds change, and your preferences do change based off of what you’re eating.

And I think that the problem we have as a society is that, collectively we’ve gotten so hooked on the sugar that now we’re like up here in terms of the demand, in terms of sweetness. And that’s why we keep pouring it on and on and on.

Shireen: But it’s good to know that there is a way to intentionally reset that palate and that desire for high sugar foods, it seems.

Dr. Avena: Absolutely, and I think that’s something that can be daunting for people who, especially are coming off of a history of eating a lot of added sugar, maybe even for their whole life, is that they can’t imagine life without it.

And it’s hard for them to picture what are they going to eat? They don’t want to be like a bunny rabbit where they’re just eating like vegetables and fruits all day long. They want to eat the things that they enjoy. And what I often remind people is that you have to keep in mind that you need to consume foods that they’re going to love you back. You might love cakes and cookies, but they don’t love you. They’re harming you. They’re actually your worst enemy. And so, if you want to take care of your body, get yourself healthy, you have to get to the point where you can enjoy those things, but in moderation.

And I think moderation is the key. And when people talk about you hear this a lot in the media and especially from the food industry, like, oh, well, there’s nothing wrong with our products, just eat them in moderation. Well, that’s like telling a drug addict to just go do drugs in moderation.

Like you can’t. And so, some individuals are at the point where they need to completely reevaluate their relationship with food and get to the point where they’re not dependent on the sugar. So that at some point, hopefully they can reintroduce it. And be able to enjoy a cookie or a cake now.

I think that the difference between drugs and the difference between sugar is that most people if you tell someone you’re addicted to alcohol or addicted to hard drugs like heroin or something like that. The advice is going to be you have to quit them, right? Cold Turkey, you can never do them again. They’re bad for you. Sugar’s different though because sugar is in so many different things that we eat.

I mean, could you imagine how hard it would be to quit drinking alcohol? Like you didn’t know if your eggs had alcohol in it. I mean, it could be anywhere, right? And that’s how it is with sugar. You go to a restaurant, and you are really rolling the dice as to what you order as to whether or not it has sugar in it.

And so, I think for most people it’s really difficult to kind of come to terms with the relationship that they can have with sugar because it’s so pervasive. And so that’s why I don’t really advocate a cold turkey like you need to quit it altogether approach, because I don’t think that’s going to work. I’ve seen it fail time and time again, and I talk a lot about this in my book, Why Diets Fail.

Our society is not supporting a culture that’s going to allow us to quit sugar. And our brains aren’t supporting a society that’s going to allow us to quit sugar because we’re going to desire it. So, I think it’s really about getting your relationship to be a healthy one with sugar. Getting rid of the dependence, breaking up those bad habits, and then being able to regain that control.

And to me, that’s the piece that allows people the freedom to be able to enjoy these things in moderation, finally

Shireen: You know, speaking of control, there’s also a correlation between the food that we eat and our mood especially healthy food, and then our mood. Can you speak to that correlation?

Dr. Avena: Yeah. So, I think a lot of people feel that if they are in a bad mood, that if they eat some junk food or sweets, it’s going to improve their mood. And we see this happening all the time. People self-medicate with food. It’s a way to modulate not only your feelings about happiness or sadness, but it’s also a way to manage anxiety.

I’ve seen so many people who have low level anxiety disorder that are able to basically get through life without needing a prescription because, or therapy because they’re able to manage it to some degree by titrating their sugar throughout the day. I think that that is something that we really need to be careful about.

And because that’s part of the reason why people are getting extra calories, getting extra sugar in their diet that they don’t need, and they’re also not really coping appropriately with whatever it is that’s causing their anxiety. And so, I think that when you realize you’re using food to self-medicate or you’re using food to soothe yourself, it can really kind of help you to reevaluate that relationship because if you think about it, those foods are actually kind of fooling you. They’re not making you feel better. They’re actually probably increasing your anxiety, and you’re better off using food as a way to fuel your body.

 as opposed to using food as a way to deal with your mental health.

And so, I think that focusing on eating whole foods, eating lots of vegetables and fruits and protein and nuts and all of these things, avoiding the processed foods, it can really help to stabilize your mood. And I’ve heard this time and again from individuals who’ve changed their diet, that they don’t have those ups and downs.

Because they’re not having the sugar spikes that are driving your blood sugar up and your insulin levels off throughout the day. You’re much more even keeled, and a lot of people haven’t experienced that in years, to be quite honest, because they’ve been hooked on sugar for so long.

So, it’s really an amazing feeling when you’re able to see how your diet can inform how you feel and it’s an easy fix, right? I mean it, it’s easy in the sense that this is one thing we can change right now. I can just choose to eat different things and I’m going to really feel good. And for many people, that’s the motivator. Forget about like looking a certain way physically or weight loss. A lot of people sort of feel good. And so, food can do that. When you eat the right food, you’re going to feel great.

Shireen: What is the role or relationship between sugar and depression?

Dr. Avena: It’s a really great question. Sugar and depression are very tightly linked. And again, much like with anxiety, we see a lot of times people will try to manage their feelings of depression with sugar and with sweet foods.

And so, a lot of times people are sad, or going through a rough time. Instead of maybe turning to drugs and alcohol, they turn to sugar. And so, this isn’t, again, I think a pervasive problem that we’re seeing in that people are dealing with mental health issues in the wrong way.

And one might say, oh, well it’s better than, getting hooked on alcohol or drugs. Yeah. Okay. Maybe for now. But if, you know someone has issues related to depression and they’re treating it with sugar now they’re giving themselves high risk for coronary artery disease and high risk for diabetes and cancers and all these other problems.

And so, I always say you don’t want to cure one problem by causing three more, right? And so, if sugar’s going to make you feel better temporarily, but going to cause you a headache with three more issues, now you got to deal with, and that makes no sense. And so, getting, I think away from using food to soothe ourselves and to make us happy is so important. It’s not designed to regulate our emotions. It’s designed to fuel our bodies, and if we fuel our bodies right, then our emotions are going to follow suit.

Shireen: There’s this popular term that just sort of used around, but it’s called being hangry. Which is a combination of being hungry and angry.

This is really a phenomenon that a lot of people experience. Can you help us understand one, what it really is? How are they correlated? And then what is the explanation for this occurrence?

Dr. Avena: Yeah. Hanger is real. I’ve experienced it. I think we all probably have at some point. So basically, when you become hungry, to the point where you really need to eat something, you can have your emotions dysregulated and it’s your body’s way of basically fighting to get you to get something to eat.

And so, you’re going to be focused on just getting something to eat and not want to be talking to other people or doing other tasks or things like that. It’s really our bodies and our brain’s way of kind of hyper focusing us on the fact that we need something to eat, we’re hungry.

Now the thing, hangry is that there is this true hanger that’s designed to allow us to make sure we have enough calories and nutrients. And so, if you go too long between a meal yet, your body’s going to react and you’re going to be feeling hunger pangs and you’re going to have perhaps this emotional piece of feeling a little angry and irritable that goes along with it.

But what a lot of people experience is sugar hanger. And so, this is basically where, you’ve gone this roller coaster of sugar binges throughout the day, and when you’re at that low, you start to get irritable, and you start to get cranky. And it’s because your brain has been programmed to want more sugar.

And so now you’re at that point where your brain wants the sugar. It’s not even that you’re actually hungry, it’s just that you have this desire for sugar, and this is part of this whole addiction cycle. So, you’re kind of at the low, where you’re in almost like a withdrawal state where you’re feeling Ill, irritable, maybe cranky, maybe even lethargic.

And so, what I experienced in the people I’ve been working with and in our research studies, is that that’s the most common form of hangar. It’s when people are actually just hooked on sugar, and they haven’t had it in a while. And so, it’s the addiction response that’s occurring.

Shireen: The next question for you on this actually, so where do we go from here? I guess, what is the light at the end of this tunnel, right? Because we’re, the odds just seem against us. Foods are sort of hidden into a bunch of different foods, eating out, eating processed foods, anything. Where does one go from here? And then also within that, can you speak to restrictive dieting and the implications of that, but help us understand, how do we recognize any kind of addiction, sugar addiction and then where do we go from there?

Dr. Avena: Well, recognizing whether or not you’re addicted to sugar, I think it’s something that you can do. There’s different types of tools online. The, for instance, the Yale Food Addiction Scale is a scientific tool that was developed a couple years after we started publishing some of our studies on sugar addiction. And that’s a great way to assess whether or not you meet the criteria for having an addiction to food.

And so that can be a very easy way to see kind of where you fall. Also, like I said earlier, I think it’s really about, you know, the negative consequences and the loss of control to me those are the two main pieces. If you feel that you’re experiencing one or both of them, then it’s time to start to think about maybe there’s an addictive component to what’s going on.

And I don’t want to paint the picture that it’s all doom and gloom and our food, you know, supply is killing us. I think we can get ahold of it. I think it’s really though about not just going with the flow of all these processed foods. It’s about. Standing up and saying, you know what, I don’t eat this way. I’m not eating those foods.

I don’t even consider them foods, to be quite honest, and I’ve started talking about this a lot in different presentations that I give. Things that are in packages and these snacks that are designed for kids to take to school and whatnot. To me it’s not food.

You can give them to your kids here and there, but you also got to give them actual food. And so, I have kind of broken them out in my lexicon as different things. They’re not part of our food supply. They’re these like other things that are out there distracting us from the healthy things we should be eating.

And so, I think if you could focus on the real foods and the processed foods, let them be a distraction. That’s a really good way to kind of look at it. Also, I think you asked about restrictive dieting. I’m not a fan of it. I know that this intermittent fasting thing, people are talking about it, people are finding that it’s beneficial.

There’s lots of research studies on it, and there’s some that suggest that it can be helpful. My experience is that if you send it, it depends on how you define intermittent fasting. For example, I’ve seen some people say they’re intermittent fasting because they don’t eat anything past like eight o’clock at night and then they go to bed and wake up and eat breakfast.

Oh, okay. That’s like normal eating to me. I don’t feel like that’s intermittent fasting. But yeah, if that’s what you want to call it to make yourself feel like that, you’re doing the thing that’s going to work. Awesome. But I think having these extremely restricted food windows is not a good idea because that’s just going to promote binging.

And it’s just going to, again, you got to think about your brain and think about how your brain’s responding through the way you’re eating. And if your brain’s only getting food for like six hours a day then your brain’s going to be reacting accordingly, causing you to crave. It’s going to have different effects on your metabolism.

So, I think people need to be very mindful about the intermittent fasting and having these extremely brief windows. And then lastly, I think dealing with sugar addiction. I think it’s something that 20 years ago when I first started doing research on this topic, people would have really struggled because doctors didn’t think it was a real thing.

They didn’t want to even hear about it. Our research colleagues were like, you guys are crazy. This is silly. Why are you studying this? But now we’ve seen that because there’s so much research out there around it and there’s so much evidence now that suggested it can be addictive, that more and more medical doctors, more and more programs are available to treat food addiction.

So, it’s become more accepted in the medical community, so it’s easier for people to get help. So, I think that people shouldn’t be afraid to talk to their doctors about this because there are avenues in which you can get help if you feel like you can’t do it on your own.

Shireen: Perfect. With that, we are toward the end of the episode. Dr. Avena, this is such an amazing conversation. I feel like we can have a like a whole other episode with this. There’s just so much to this. At this point, I would love for our listeners to know how they can connect with you and just learn more about your work.

Dr. Avena: Yeah. So, if you want to learn more about our research and different things happening in our lab, you can check out our website. It’s drnicoleavena.com. And also, you could follow me on social media. I’m at Dr. Nicole Avena.

Shireen: Perfect. And with that to all of our listeners, a quick question for you. Head over to our social media and answer this question. Which is pretty much asking you how are you planning on tracking and really understanding if you have a sugar addiction.

So based on this episode, what did you learn that will help you tackle some of these challenges associated with sugar addiction?

 Head over to our Facebook, our Instagram. Find this podcast episode and comment below and let us know exactly how you plan on tackling that, and we will see you there after the episode.

But with that, Dr. Reena, can’t thank you enough for your time. Thank you so very much. It was such a pleasure.

Dr. Avena: Oh, thank you. Great to talk with you.

Shireen: Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media at Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions, and to chat and connect with us about your journey and perspective.

You can also visit our website, Yumlish.com for more recipes, advice, and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week’s show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we’ll see you next time. Remember, your health always comes first. Stay well.

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