Bonus: Dr. Nicole Avena – Sugar is A Drug


Jonathan: Hey everyone. Jonathan Bailor here with another bonus, Smarter Science of Slim podcast. I’ve got to admit friends, I am a little starstruck. A geeky starstruck because we have one of my favorite researchers in the world. A woman whose work I actually quote heavily in my upcoming book and just someone who I really think is going to blow the roof off and just shine a spotlight on what I believe we’ll look back in a few decades as one of the great catastrophes of public health. That is none other than Dr. Nicole Avena and she is the author of the upcoming book, Why Diets Fail. She is a neuroscientist with a PhD in psychology and what was the other one Nicole? Sorry.

Nicole: Science.

Jonathan: There it is. She’s also – but she focuses on the fields of nutrition, diet, and addiction and specifically what has made me such a big fan of Nicole’s work is the amazing clinical research she has done on the addictive properties of sugar and added sweeteners. So, Nicole, welcome to the show.

Nicole: Thank you very much Jonathan. I’m happy to be here. Thank you so much for the very kind introduction.

Jonathan: Well thank you so much for your amazing work. I am so excited for your upcoming book, Why Diets Fail. If you don’t mind Nicole, I just want to jump right in. I’ve got some select quotes here I pulled from your papers and I just want to dig into them because truly I think without knowing that this research is coming from a true expert in the field like you, people could be like, “This is sensationalized.” But I’m going to quote directly from your peer reviewed academic research here. Is that okay?

Nicole: Oh, sure.

Jonathan: Okay. Cool. So, Nicole. In one of her many fabulous clinical works here tells us that caloric sweeteners are unique in their ability to, I’m quoting directly here, “Trigger a series of behaviors similar to the effect of drugs of abuse.” Then you go on to continue that these are categorized as “Binging; Meaning usually large bouts of intake, opiate-like withdrawal, indicated by signs of anxiety, behavioral depression and craving measured during sugar abstinence as enhanced responding for sugar. There are also signs of both locomotor and consummatory cross sensitization where sugar and drugs of abuse, aka, animals fed sugar are more likely to consume amphetamines, cocaine and alcohol.” Nicole, this is terrifying. Tell us more.

Nicole: Well, it is a little bit terrifying but unfortunately it’s the case. So I’ve been spending, I guess, a little over ten years now trying to understand why it is that so many people find it difficult to cut back on overeating all these delicious palatable foods that we have access to these days. I started off doing research in laboratory rats because those are great ways that we can understand what’s happening in the brain. A lot of the studies that we’ve been conducted have been done in animal models, but we’ve also done some work in clinical models where we ascertain in people whether or not they meet some of these criteria for addiction that we’ve been able to see in our lab rats.

Basically what we’ve done is a series of experiments looking at animals that are offered a high sugar diet and as a result, when animals are overeating this high sugar diet, they start to show a whole bunch of behaviors and a whole bunch of changes in the brain that really look like they’re addicted to a drug of abuse. So, not only do they show signs of tolerance, they show signs of withdrawal if we take the sugar away. They’ll engage in behaviors that suggest they’re craving it.

We’re also able to see changes in their brains that are much like what you would see if you look at the brains of a drug addict. So changes in dopamine and opioid systems, which are two of the key neurotransmitters that are involved with drug abuse. The data basically suggests that when an animal or, in many cases, a person is overeating a palatable food like one that’s rich in sugars, it can change the brain. It can produce a state in which they are compulsively overeating the sugar and it’s like an addiction to food.

Jonathan: Nicole, you really hit the nail on the head there where it’s this – you’re saying your research of binge-like manner, over consuming, because we don’t want to say, for example, like any food that contains any sugar is bad for us. Clearly that’s not the case. We’ve got healthy fruits and healthy vegetables, but the challenge in as you described is when we do this in a binge-like manner – but the binge-like manner is now so easy. I mean it’s almost impossible to avoid – if we don’t eat a whole food – if we were to eat sugar cane, we would probably never do this because we’d have to eat like eight feet of sugar cane, but when you drink a soda, that is essentially a binge. Is it not?

Nicole: Well, yeah, I mean in many ways you’re right Jonathan. We’re in a situation now with our food environment where there is sugar in so many of the foods that we consume. A lot of times we’re blindly consuming it. We don’t necessarily realize how much we’re consuming in any given day because it’s in so many foods that we don’t even know about. That’s one of the challenges I think people face is that they are inadvertently over consuming and inadvertently binging on these types of palatable foods.

You’re right though, it’s important to note that certainly it’s not a bad thing to have a little bit of sugar. We see this in our studies that we do in the laboratory when we have control groups that are exposed to just small amounts of sugar, have it occasionally. You know, once in a while. Those animals don’t show signs of addiction. They don’t show these changes in the brain that look like they’re addicted to drugs. It’s only the animals that are over consuming sugar that are showing these changes in the brain. It’s important to note that we see this now happening in clinical studies as well. There’s been some more recent studies using brain imaging in humans and those studies suggest the same thing. It’s when people are obese and over consuming highly palatable foods, that they’ll show these changes in their brain that look like what you’d see with drug addiction.

Jonathan: Nicole, the thing that’s so scary is if we go down the route of not eating food, which I define as things we can find directly in nature, and we go down the route of eating edible products to even eat a normal amount as you mentioned, we’ll be too over consumed sugar. It is literally not – If you are eating a packaged and processed foods, just flip the label over. You will be over consuming sugar no matter what. It’s just the cost of doing business if you choose to go that route.

Nicole: Right. Part of the problem is the labeling, so when you look at the back of your favorite product as you put it, which is a good term, there’s a lot of different things that go into a lot of these processed foods. There’s a whole bunch of names on the back and if you just simply look for the word sugar, you’re actually going to be misled because sugar has many names. It’s not just sugar. There are things like high fructose corn syrup, which is an added sweetener. Corn syrup. There’s a whole host of names that basically all point to the word sugar. There’s lots of different ways to say sugar.

You really need to be aware of the labels and understand what you’re eating and understand what the ingredients are in order to get a fair assessment of how much sugar is in the foods that you’re consuming. Something could appear to be sort of moderate in sugar intake, but when you really get down to the nitty-gritty, it probably contains a significant number of calories from sugar.

Jonathan: Oh, absolutely. Nicole, I don’t think people actually realize – a lot of those foods that contain “a lot of sugar” when we say a lot of sugar, and we look at it from a percentage perspective, and again, I don’t mean to throw these foods out the window and say you can never eat them. For example, skim milk gets more of its calories from lactose, which is a sugar, than from any other component for lack of better terms, of that food. People don’t realize that. It’s like when you drink skim milk, you are drinking mostly sugar.

Nicole: Right. My favorite example which is another one that’s marketed more toward being a healthy product is Vitamin Water. Ninety-six percent of the calories are from sugar. You’re just drinking liquid sugar so it’s important to think about how many calories are coming from the sugar in addition to how much sugar is contained in the product. You don’t want to be eating something or drinking something that’s largely just sugar calories. That’s not good.

Jonathan: Nicole, you also made a point there is just so critical and that is – so the two things, one, you’ve got to look at the number of calories you’re getting from sugar. You also have to look at the label because it’s not always called sugar. It’s called all sorts of different things that are even made out to be seemingly health foods. Like agave nectar and all-natural cane juice and the bottom line, is if it’s an added sweetener, meaning if it’s not – and even if it’s naturally found in it, that might not be good for everyone, but if it’s added, it’s probably not a good idea. Right?

Nicole: Yeah, I mean, I would say that people if they have to choose which foods they should go for, they obviously the first choice is to try to eat things that are sweetened naturally. By naturally we mean they were put there by nature. Not in a processing plant of something like that. So fruits that contain sugar I think would be a safe type of sugar consumed. Again, we do need to be aware of the processed foods that we’re consuming that contain lots of added ingredients, many of which are sugars.

Jonathan: That’s this labelees [sic], as I like to call it, is in some ways a slippery slope because no matter how – at least this has been my experience. No matter how much of an expert we become in reading labels, food manufacturers are always going to find a way to call an added sweetener something different or to shrink the serving size to be so small that if you don’t take the time to look at the serving size – you look like, “Oh, my gosh. This only has six grams of sugar. I’m fine.” Then you’re like, “Oh, serving size is half a cookie.” You’re like “Blast.”

Nicole: Right. It’s true. You have to be a careful consumer these days. Many of us have to really do a lot quick math in our heads when we start to look at a lot of these different food products to be able to figure out the amount that you’re presented with and how many calories that actually is. Not necessarily the serving size like you suggest. It’s true. This is why it’s important I think for the public to be up on the latest research and so people could be aware of the different names for sugar, what’s going on in terms of figuring out how to dissect these labels on the back of our food products they can really understand what’s in the foods that we’re consuming so that they can make informed decisions. So that they know how much sugar is contained in a particular food that they might want to eat so they can make an appropriate decision about how much of it they should eat if they want to eat it at all.

Jonathan: Nicole, I love the way you phrase that. It reminded me of some wonderful advice my wonderful mother gave me. She said, “Jonathan, if you’re in a situation where you’re trying to decide if taking an action is good or bad, and you have to think about it and you have to think about it a lot, it’s probably bad.” You probably shouldn’t do it because if it was really good for you, you’d know. You’d know that this is the right – It is the right thing to help this lady cross the street. If you feel like you need to freakin’ get out a microscope and a calculator when making a food choice, chances are that’s not a good choice for you. Right? Like spinach is healthy. We get it. Right? Like salmon is healthy. We get it. Is GoGurt healthy? Well, what is GoGurt? What? Just don’t eat GoGurt.

Nicole: I agree. I think making things as simple as possible is really the way to go when it comes to our foods. My advice to people is to have a sort of short list of foods that you know are safe and healthy to eat for your particular health goals. Those are the foods that you should try to stick to. You’re right, if you have to think about it too much, then that gives us cause. That makes us think that perhaps there shouldn’t be so much thought that needs to go into deciding what we should eat. It should be pretty clear cut. If it isn’t, then you might want to think twice about crossing that food item off of your shopping list.

Jonathan: Nicole, one thing I really wanted to dig into. Now this is as much me being a fan and a listener and asking for your advice as it is being the host of this show. Because again, your research really is on the cutting edge. People often ask me, they say, “Jonathan, I like the taste of sweet and I’m not going to give up sweet taste for the rest of my life.” And I’m like, “Well good news. You don’t have to.” Generally, if it were a spectrum of ways to get, for lack of better terms, added sweetness. Like if you need to add sweetness to thing, tell me what you think about this. Just be totally straightforward with me. Totally straight with me. The worst offender – I generally –I will put them three buckets. The worst offender would be caloric added sweeteners, like sugar, high fructose corn syrup, yada, yada, yada. We get that. Better, but still not good, not something I would recommend, but better, would be a non-caloric artificial sweetener such as like a sucralose, things like that. Better than that, and something that I would actually, not recommend, but it’s pretty close to being benign, would be a natural sweetener that is not nearly as detrimental such as like a xylitol or an erythritol or a stevia. What do you think of that stack rank?

Nicole: I agree. I think that, again, it’s important to underscore that if you have something that has real sugar or high fructose syrup in it once in a while, it’s fine. But if we’re talking about sort of as the primary component of our diet or something that we’re going to be regularly eating, I think that that rank order is reasonable.

One thing that you have to keep in mind though when we think about the addiction literature and the research that has been going on not only in my lab, but in other laboratories as well, is that, remember, it’s the sweet taste that seems to be associated with this reinforcement effect that we feel on our brain when we over consume sugar and some of these other hyper-palatable foods. My cautious warning to people about using some of these other types of sweeteners that you suggest, particularly artificial sweeteners, is that yes, they’re good and that you are able to not get the calories from the sugar, but you have to keep in mind that you might still be perpetuating those brain systems that are being associated with addiction to actual sugar.

It could be really a band-aid if you will. Now, like I said, someone’s eating it in moderation, I think it’s fine. As opposed to just simply replacing all the sugar on your diet with artificial sweeteners and some of these other more healthy sugar solutions, I don’t think that’s going to help people if they’re trying to reduce their intake of sugar and anything just sort of help them along and continue to cause them to crave sugar.

Jonathan: Fascinating. I really, like that. Nicole, I wonder if there’s a sweet spot to use a little bit of a pun here, which is pretty lame, but it’s early in the morning here in Seattle so I’m doing the best that I can. Let me give you an example of a place where I, and this might sound a little shocking, use added sweeteners, but the sweetener I’m using is xylitol. I love pure, un-dutched, raw cocoa. Fantastic source of healthy fats, nutrients, anti-oxidants, all kinds of fun stuff. But if you’ve ever tried to eat that food by itself, it’s a bit like drinking paint thinner. It is foul. That’s why candy bars have a lot of sugar in them. If I take some raw un-dutched cocoa and I combine just a bit, just a few teaspoons of xylitol, I’m able to, it’s not actually sweet, it just tastes like a very, very deep chocolate bar. Like and eighty-five percent or one hundred percent cocoa chocolate bar. Then I’m able to enjoy that incredibly healthy food. What do you think about a strategy like that? Where it’s not really sweet, it just makes it not disgusting.

Nicole: Sure, I think it sounds like you’re simply adding something to kind of mask, I guess, the bitterness of the cocoa powder. Is that what you mean?

Jonathan: That’s absolutely. bYeah, most people don’t realize it but cocoa is horribly bitter by itself. So you need a little something or you’re probably never going to be able to eat the wonderfully healthy food that is cocoa.

Nicole: Right. I agree and I think people have to – you have to do what’s going to work for you and I think if you have these little strategies here and there you can use to help you to make your diet primarily healthy, I think it’s fine. Adding some of these types of things that you suggested would be a good way to do that. It’s just that we need to be mindful of how much we’re doing it and how often we’re doing it. So if you’re adding this and having your cocoa five times a day, that’s probably not a good idea. But if it’s once in a while, then yeah, that’s fine.

Moderation is key and monitoring ourselves is key and making sure that we’re aware and keeping our intakes in check. I think that’s really the way in which people can control their intake of sugar rich foods and as a result, keep their body weights down.

Jonathan: Nicole, it actually sounds very, very similar to really any of these types of substances which are not just completely should not be enjoyed in any dose like cocaine for example or like heroin. Alcohol, for example, most people don’t say, you can never, ever, ever drink alcohol ever. They just say you should be conscious about when you drink. You should be aware that it is a powerful substance and it should be treated with respect and consciousness.

In your research, again I’m going to quote you directly here. It’s just a profound statement. You say, “Based on observed behavioral and neuro-chemical similarities between the effects of intermittent sugar access and drugs of abuse, we suggest that sugar, as common as it is, nonetheless, meets the criteria for a substance of abuse and may be addictive for some individuals when consumed in a binge-like manner. Given the similarities, between sugar and controlled substances, such as alcohol and nicotine.” Why? Certainly we don’t ban alcohol. We don’t ban nicotine, but we, for example, don’t allow them to be advertised on Saturday morning cartoons. Why don’t we do the same thing with the addictive substance, that is sugar.

Nicole: Well, there’s a lot of people out there who are trying to change that. There’s a fair number of people who are interested in getting policy put forward that would regulate advertisements for children and would have some regulation in terms of how much sugar-sweetened beverages you can consume in the sense that we would limit the portion sizes that are available. There some steps being taken I think to begin to possibly think about treating sugar in a way that we can somehow regulate it. It’s very controversial as you can imagine because a lot of people don’t want that to happen. They want to have personal responsibility over their food which is certainly something that we all want to have.

Nonetheless, it’s true, there are similarities between the effects that we see with these high sugar foods and with alcohol and with drugs of abuse. Whether or not we’re going to see sugar regulated in the same way that we see alcohol regulated, has yet to be seen. We’ll have to see. Over the next couple of years I think we’re going to be seeing a lot of the activity regarding that. As more and more people are becoming aware of the research that’s going on in this area and also becoming cognizant about the amounts of sugars that are in different foods that they consume.

Jonathan: It’s very well stated Nicole. The thing that just continues to shock me is like I totally get – I totally understand people saying it’s ridiculous that an adult can’t buy a soda of whatever size they want. I get that because you could buy as much alcohol as you want once you’re over twenty-one, so I get that. However, what I don’t get is the complete non-regulation around children, because children are not adults yet. They’re not necessarily able to be as conscientious.

In fact, given their pre-disposition to – I mean they’re already got this hormonal chaos going on. They’ve already got excessive energy going. To say that there should just be nothing, nothing. Not only nothing, but even a celebration. We explicitly target sugary foods at children. Not only is it not regulated, but it’s almost counter-regulated. It’s like we’re intentionally spending the most time and the most money focusing our marketing of these foods on the small people who essentially can’t resist it. It just seems like that is literally immoral. That’s my personal opinion.

Nicole: Yeah, well it’s true. There’s a lot of research and a lot of people who have the same line of thinking as you. It’s true, the obesity epidemic and unhealthy children are becoming the norm. We’re seeing that among young children, even toddlers now, we’re seeing being overweight. Really young kids developing Type 2 diabetes, whereas, fifty years ago, kids didn’t get Type 2 diabetes, it was rare. It’s definitely something that’s on the public health screen now and we’re starting to see a lot of interventions coming into place to try to educate children about the dangers of drinking sugar-sweetened beverages in excess and eating junk food in excess, but you’re right, they’re kids. They don’t always take the information that they know to be true and apply it. It’s really up to the parents to do that and to teach them that proper nutrition methods.

I think a lot of this education needs to first be geared toward the parents so that they can help teach their children what are appropriate types of foods that they should eat. Teach them how to eat in moderation. I think we’re going to see a lot more research coming out about how this can affect children, particularly with the addiction side of it, because you’re right, a lot of these foods are being marketed. My favorite is the sugar-sweetened cereals. They always have some sort of cartoon character on the box and they’re really sort of pushed towards children. If kids are the ones that are sort of falling victim to the effects of overeating these sugars and they’re starting off early in life, then it’s going to set them up for a lifetime of potential health problems that we want to try to mitigate.

Jonathan: If not only for the individual or the collective good. Right? If an individual has to spend ninety years as a diabetic, someone is paying for that. Someone is paying for that. That’s millions of dollars. It’s for that one individual to give someone insulin therapy for ninety years is millions of dollars. Is it not?

Nicole: It is. When I give lectures on this topic, I often remind people that being overweight or developing Type 2 diabetes, these aren’t necessarily just medical problems. There’s a whole host of associated problems that go along with having increased body weight and potentially developing diabetes. Of course, all the medical risks that are associated with that, but there’s also the psychological factors. People who are overweight, particularly kids that are overweight, they struggle in school. They have a hard time with relationships. It’s just not fun to be an overweight kid.

Also, as you mentioned, there’s economic consequences. All these medical crises cost a lot of money. The burden of that is going to fall upon us as a society. That’s something that we need to think about when we’re talking about children who could potentially be developing these disorders like diabetes in their early ages.

Jonathan: Nicole, it is literally something I think we’re going to look back in decades and just scratch our heads and say, “What were we thinking? What is going on?” It’s a bit like when you look back at the way cigarettes – I mean anyone who watches this very popular show Mad Men, you look back and there’s like, “My God, everyone smokes.” Doctors are like, smoking is okay for you. We’re like, “That’s crazy.”

Again, folks, please understand that this is not just like random person off the street. Nicole is a PhD in neuroscience and psychology from Princeton and she’s a post-doctoral fellowship in molecular biology at the Rockefeller University in New York City. She’s got over fifty scholarly journal articles published. This is not just crazy Jonathan and crazy Nicole talking about their theories. This is science and we have to take note, don’t we Nicole? For the sake of ourselves, for our children, and for our society.

Nicole: Yeah. I think that one of the things that I think is great about doing this podcast is that you’re really taking the science and bringing it to people, because part of the problem is that there’s lots of scientific experiments that go on that are conducted and it – they get published in these scholarly journal articles and not very often do they really find their way out into the public. It’s up to people like you, Jonathan, to help educate everyone and to really teach everyone about what are these studies telling us? What does this mean?

We need to take the information and use it. So it’s up to people to take the science that’s been conducted and to make some informed decisions about what they want to do about their health. What they want to do about their food choices. You’re right. When you mentioned about Mad Men, how it used to be back in the sixties and seventies with smoking. It’s a different era and it’s going to take societal changes in order for us to really make a difference in terms of the way that we perceive the types of foods that we eat, the way we want to feed our children and the decisions we want to make regarding the types of things that we perceive to be foods. I think the more information we can get out there to people, the better it’s going to be. People can make good decisions about food choices and we’ll, as a group, be able to be healthier.

Jonathan: Well obviously Nicole is so important as you mentioned to get the information out there and it’s even more important to have people like you literally creating that information. Listeners, you often hear me talk about actual experts and how actual experts generally aren’t seen on TV wearing spandex because they’re in a laboratory wearing a lab coat. If you go to Nicole’s website, which is doctornicoleavena.com and her last name is spelled A-v-e-n-a. You got her wonderful smiling face right there in a lab coat because she is an actual expert and she is on the front line of research which, without question, is going to save tens, if not hundreds of thousands of lives once it starts to influence the policies that it needs to. So, Nicole, I just want to personally thank you for that. Thank you.

Nicole: Oh, thank you Jonathan.

Jonathan: Nicole, this is just a wonderful conversation. Listeners, again, Nicole has a book, a popular book coming out. She’s already got a bunch of wonderful, written work you can find on PubMed but that might not be as interesting to you, but her book, Why Diets Fail, is actually coming out right around the time of my second book, The Calorie Myth, so Nicole and I are going to be out there on the front lines trying to tell everyone why diets fail and how there are all these calorie myths and we’re going to hopefully create a world where we’re not saturated with all of this insane sweetness. Right, Nicole?

Nicole: Yes. That’s the goal.

Jonathan: I love it. Well, Nicole, thank you so much for joining us today. I would definitely love to have you back because I have a list of notes. I only got half way through my notes here so I’d love to have you back if you’re willing.

Nicole: Oh, I’d definitely would be happy to come back any time.

Jonathan: Well thank you so much, Nicole. I really appreciate you sharing your time with us. Listeners, I hope this has been helpful. Of course, the good news is, right, it’s not that we can’t eat food. We can eat a lot of great foods. Let’s just not eat products that have sweeteners added to them. It’s not about starving ourselves. It’s just about enjoying actual food. Let’s eat more and even exercise less, but do that smarter.

This week we have the pleasure of hearing from Dr. Nicole Avena. Dr. Avena is a research neuroscientist and expert in the fields of nutrition, diet and addiction. She received a Ph.D. in Neuroscience and Psychology from Princeton University, followed by a postdoctoral fellowship in molecular biology at The Rockefeller University in New York City. She has published over 50 scholarly journal articles, as well as several book chapters and a book, on topics related to food, addiction, obesity and eating disorders. She also edited the book, Animal Models of Eating Disorders (2012) and has a popular book of food and addiction coming out in 2014 (Ten Speed Press). Her research achievements have been honored by awards from several groups including the New York Academy of Sciences, the American Psychological Association, the National Institute on Drug Abuse, and her research has been funded by the National Institutes of Health (NIH) and National Eating Disorders Association. She also maintains a blog, Food Junkie, with Psychology Today, and is here to tell us how sugar is absolutely a drug.