Sugar and the Brain: Overcoming Addiction & Overeating

Nicole Avena, Ph.D

Hi, I’m great. How are you?

Sanjeev Goel, MD, FCFP (PC), CAFCI

Good, good. I’m so thankful that you could join me for this hour to talk about sugar and effect on the brain. And, before we get started, let me do a little bio. Is that okay? Give your bio?

Nicole Avena, Ph.D

Oh, sure.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Okay. So, Dr. Nicole Avena is a Research Psychologist and Neuroscientist, who’s an expert in the fields of nutrition, diet, and addiction. She’s received a Ph.D. in Psychology and Neuroscience from Princeton University in 2006, followed by a postdoctoral fellowship at Rockefeller University. Dr. Avena presently holds a faculty position of Assistant Professor at Mount Sinai School of Medicine in New York. She’s also a visiting professor at Princeton University. Dr. Avena has published over 90 scholarly journal articles on topics related to diet, nutrition, and overeating. 

Her research achievements have been honored by awards from groups, including the New York Academy of Sciences, The American Psychological Association, and the National Institute on Drug Abuse. She’s also the author of several books, including; “Why Diets Fail”, “What To Eat When You’re Pregnant”, and “What To Feed Your Baby and Toddler”. When she reviews the research on food addiction, as well as, the nutritional effects on brain development and behavior. Her latest book, “What To Eat When You Want To Get Pregnant” is due for release in the Spring. She has also edited two academic titles, “Hedonic Eating” and “Animal Models of Eating Disorders”, now in its second edition. I just saw the “Hedonic Eating” as, that’s your latest book that people can get, right, is that correct, or?

Nicole Avena, Ph.D

“Hedonic Eating” is available, but the latest book that people can get is “What To Eat When You Want To Get Pregnant”. That’s going to be out April 1st.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Oh, okay, great. And, Dr. Avena regularly makes public speaking appearance to discuss her research and discoveries throughout the United States, Europe and Asia. She’s regularly asked to speak to several special interest groups, industry groups, and schools. She has appeared on several television news programs as well as daytime TV shows, including “The Doctors” and the “Dr. Oz Show”. Her work has been featured in many popular national newspapers and magazines. So, welcome.

Nicole Avena, Ph.D

Thank you.

Sanjeev Goel, MD, FCFP (PC), CAFCI

So, maybe let’s get started to kinda talk. I like to talk about how did you get into this understanding and get interested in sugar and addiction that to me is interesting

Nicole Avena, Ph.D

For me, I kinda just stepped into this. I was starting to do my Ph.D. at Princeton University, this is going back many years ago, and I was talking with my advisor at the time about what I might do for a dissertation project. And, I’d always been interested in neuroscience and the brain, and motivated behaviors. Why people made certain decisions and didn’t make other decisions, even though they might be better for them. And we started talking about this idea of maybe there’s something more to this obesity epidemic that’s happening. Maybe this isn’t about willpower or about the fact that people just can’t control themselves. Maybe this is something that’s associated with the types of foods that we tend to eat. These highly processed foods that contain lots of added sugars. 

So, we started with this idea that maybe sugar could be addictive like drugs of abuse are addictive. And so, it really just started off as a dissertation experiment that led to be a career for me essentially, because this is almost 20 years later, and I’m still working on my dissertation. Although I did graduate, I still am doing the experiments that are related to the initial one. So yeah, that’s really how I got into it and it’s been great because I think that when we first started doing this research there wasn’t really any research on the topic of sugar addiction, but now we’ve seen over the years, that’s completely changed.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Right, so maybe just tell me about what is the latest science on how sugar impacts the brain?

Nicole Avena, Ph.D

Well, we’ve learned so much over the years about how sugar and processed foods can have an impact on the brain. And what we’ve seen in our laboratory and what other people have seen in different laboratories throughout the country and the world in fact, is that when people overeat sugar it can have an impact on the brain that looks like what happens when people are using drugs. So, when we take a look at these SMRI images of a person who is not eating sugar and then it compare it to a person that is overeating sugar, the images are identical to the types of images we would see if we looked at someone who wasn’t using cocaine and someone who was using cocaine. So, we’re able to see that there are significant neural overlaps in activation of reward related brain regions in response to overeating sugar. 

And this is part of the reason why so many people have a difficult time cutting back and trying to eat healthy because they’re constantly being pulled into this vicious cycle of overeating because of what’s happening in the brain, that sugar is able to do. And, we see not only the neuroscience side of this, but also the behavioral side. And I think many people can relate to the feelings of wanting to maybe hold back on eating sugary foods or cutting back on carbohydrates but feeling compelled to do so, feeling that they can’t avoid them, that they can’t say no. And that’s because we, again see these addiction like behaviors emerging, binging, withdrawal, craving all these things that we typically used to think about just with respect to things like drugs and alcohol. We now see plenty of evidence for, with foods, especially with sugars.

Sanjeev Goel, MD, FCFP (PC), CAFCI

So how does it compare? I’m curious, like, okay, you’ve mentioned cocaine I assume probably heroin falls in that, and you mentioned alcohol and potentially sex. Let me, all of these other things, these are kind of addictive behaviors. So, how does sugar compare like on a milligram per milligram or like how strong is addiction of sugar compared to these other types of substances?

Nicole Avena, Ph.D

That’s a really great question, and one that I often get asked a lot. And it’s difficult to answer because we need to keep in mind that the propensity towards addiction to different types of substances is going to be based on individual differences. So for example, you or I might have no problems with alcohol, right? We could casually drink alcohol and it’s not a problem for us, but someone else might not be able to do that. They might have to completely avoid alcohol because they have certain genetic predispositions and maybe some behavioral traits that lead them to be prone to over consume, and maybe be even an alcoholic. And I think the same thing happens with other drugs of abuse. Some people can casually smoke cigarettes other people get addicted to them, so they have problems and will avoid them. And I think the same thing happens with sugar. 

There are certain people who can have sweets here and there and they can control it but there’s other people who can’t. And so that’s where the research is now, we’re trying to better understand who are the people who are most susceptible to developing a sugar addiction? Are there risk factors? Are there genetic predispositions? And one of the things that we’ve seen in the research is that there are certain people who have specific alleles to the dopamine receptor gene that put the at greater risk for developing a sugar addiction. And so these are the types of studies that we’re trying to do now and trying to better understand so that we can help people who may be at risk, or help people who meet their criteria for addiction to better understand the ideology of it for them.

Sanjeev Goel, MD, FCFP (PC), CAFCI

So, that means that somebody could have like an addictive makeup that makes them addicted, or more likely to be addicted to many different substances, not just sugar. Yeah, it’s true. Is that correct?

Nicole Avena, Ph.D

I mean, you’ve heard, it’s very true exactly. We’ve heard people talk about addictive personalities and there is truth to that. We know that there are certain individuals who are at risk for developing addictive behaviors and some individuals might sort of have that be going toward more things like drugs and alcohol. Whereas other individuals might have that same type of genetic makeup, but instead of turning to drugs and alcohol, they end up going toward gambling, or sex, or in some cases food, which can have negative consequences, just like all of those other things can when we become addicted.

Sanjeev Goel, MD, FCFP (PC), CAFCI

So, I’ve had my DNA test looking at my specific alleles looking at how my dopamine works and serotonin as well. And it showed that I have a very quick rise and potentially also a drop as well. So does that place me in the high end, is that the high risk kind of, I don’t know that —

Nicole Avena, Ph.D

Yeah, it could be. No, It could be. It could be. So, people who have certain allele to dopamine receptors have been linked to having greater propensity toward addictions. Now, again, in part that means that those individuals are more likely to have these sort of spikes and then declines in their dopamine. And so, that sort of up and down kind of change in dopamine release could be a trigger for some of these addictive like behaviors. And, I think that’s one of the beauties of modern medicine, right? 

Is that we now have all of these types of ways which we can get a better picture of what’s happening inside of us. What does our genetic code look like? And that used to be something that was almost like science fiction, but now you can order the kit online and use your little swab or give a blood sample and you’re good to go, and you can find out a lot of interesting things about yourself.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Is there a particular like allele you wanna mention like, just so like our readers, cause we’ve had Dr. Mansoor on talking about the genetic testing. So, I’m just wondering if they can just help them to get–

Nicole Avena, Ph.D

Yeah. Certainly. The DRD2 allele would be the one that’s been most tightly linked to addiction. Now, there’s certainly other alleles that have been investigated, but I think that the research really backs that one right now as the candidate gene.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Okay, and then I assume there might be, it must be interplay between the serotonin allele and the noradrenaline allele as well, or there’s not really.

Nicole Avena, Ph.D

Absolutely, absolutely. And I think, we’re really just beginning to scratch the surface in terms of understanding the genetics of addiction. I think we’ve known for years and years that addiction runs in families, and that’s been something that always hinted at a genetic component. But, it’s really only in the past several years that we’ve been able to better understand that from an empirical standpoint because of the advances that we now have in technology to really better understand what’s happening on the genetic level.

Sanjeev Goel, MD, FCFP (PC), CAFCI

And, so let’s say if someone has particular, whatever their makeup is and they’ve recognized that they may have a sugar addiction, which most of us do, what are the type of steps they can do to deal with that? How do they– 

Nicole Avena, Ph.D

Yeah, well, certainly if you meet some of the risk factors for sugar addiction or other addictions, it’s not a sentence. It doesn’t necessarily mean that you’re bound to become addicted. It just means you have a greater chance of becoming addicted than somebody who maybe doesn’t have that genetic predisposition. And so we have to keep in mind that there are other things that need to be put into place that would trigger you into going into these addictive like behaviors such as our environment. 

And, so what things I can say to people who feel like they’re struggling with a sugar addiction or overeating, is that there are a lot of resources available now that can help you to sort of walk through the steps to better understand what it means to have addictive relationship with food. I think understanding how tolerance develops, how binging behavior develops, how withdrawal develops, and what it feels like, and how to manage cravings. These are all things that can be learned and can be understand. 

And there’s a lot of different techniques that are available out there that can help people to manage their addiction, to mitigate it, and also to get help with trying to maybe change their environment in a way so that they’re not constantly being stimulated by these addictive types of foods, which can be difficult in our modern food environment, because we’re constantly being shown advertisements and different messages that signal that we should be eating. And these foods are delicious, but there’s ways in which you can recognize those things. I talk a lot about this in “Why Diets Fail”, my book. And there’s a lot of tips in here on how to understand what it is like to live with a food addiction and how you can actually break it down in a way so that you can manage it, and get away from any of these triggers that are in our modern food environment.

Sanjeev Goel, MD, FCFP (PC), CAFCI

So maybe just, if, do you mind taking us through like one nugget, like about this, about how to deal with cravings? Like how would you suggest that? How would–

Nicole Avena, Ph.D

So, craving… Yeah, craving are an interesting thing to talk about because many people think cravings are bad and in some cases they can be, when you’re craving the wrong thing. But for many of us, cravings are a natural part of the repetitive process. So, our bodies will sometimes crave certain foods. So let’s say for instance, you feel like you wanna have a hamburger for dinner tonight or a piece of steak, that could be because maybe you’re a little iron deficient. And, so your body’s going to naturally desire foods that contain nutrients that it needs, if you’re in a deficiency or almost in a deficiency. 

So some cases cravings can be a good thing. They can help us to have balance in our diet and make sure that we don’t struggle with nutrient deficiencies. But, if you’re craving ice cream that’s probably another story that usually is associated with the fact that craving for things like sweets, and candies, and cakes is more associated with the hedonic appeal of the foods. And, so those types of foods tend to release opioids and dopamine in the brain that make us feel good. And we have a memory for that. And so when we crave those types of foods we’re not actually craving the food we’re craving feeling good, we’re craving pleasure. 

And so what I often recommend that people try to do, is to find something else that can release dopamine or opioids. Find something else that’s pleasurable. It doesn’t have to be something that you eat, it could be something that you like to do, maybe a hobby or maybe just talking to someone that you haven’t talked to in a while that you care about on the phone, playing with your children, lots of different things can release dopamine and make us feel good. And I think that’s what we need to recognize. And the biggest thing I can say is, for cravings you have to wait it out and with time that urge will dissipate. And so, if you can distract yourself from a craving by just maybe, even if you have to walk around your kitchen 10 times just to do something to wait it out, that can sometimes be enough to make the craving dissipate and go away.

Sanjeev Goel, MD, FCFP (PC), CAFCI

How long do people… How long does it take for craving to usually go away in a normal person? Like, are we talking about an hour or 15 minutes? Like what?

Nicole Avena, Ph.D

Pretty short lived. Yeah, pretty short-lived, 10 minutes maybe, 15 minutes. A lot of it depends on if you put in an element of distraction. And so, you have to remember this is simple learning behavior. We’ve learned that ice cream tastes good and that releases these chemicals, right? So, we have that association. And, we’ve also trained ourselves, at least those of us who’ve been giving into our cravings for all these years, that as soon as we get that craving for ice cream we’re gonna go over to the freezer and get it, and then we’re gonna feel good. 

Now, if we waited it out, that relationship and that learning essentially starts to fall apart now we’re craving it, but we’re not getting it. And so we don’t readily hang on to that type of information. That’s learning, that’s being unlearned. And that’s essentially what we wanna do with our cravings. Is it just unlearn them. Unlearn that every time you think about a food or get this desire to eat certain types of foods that you’re gonna give in to that and reward yourself with that burst of dopamine, that burst of brain opioids.

Sanjeev Goel, MD, FCFP (PC), CAFCI

So, yeah, so I’m getting, I’m understanding that basically with sugar, it’s really, a lot of it’s about the central nervous system and dopamine, but what about like effects on like other hormones, like ghrelin or leptin, these hormones that regulate our appetite and satiety.

Nicole Avena, Ph.D

Absolutely.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Does sugar have an impact on that?

Nicole Avena, Ph.D

It does. Yeah, and it’s interesting because I’m focused mostly with my research on how sugar affects the brain, but we know that sugar actually has an impact on many of these different hormones that are related to various different processes in the body. So like you said, leptin, insulin, ghrelin, these are all things that are also being altered by excess sugar intake. And in part, they can also then have a negative impact on the dopamine system and this pleasure system that it’s put in place. And so we need to keep in mind that it’s a complicated system. And essentially when you have too much sugar it’s messing up all different parts of it. All the cogs in the wheel are really getting put it out of whack, when we consume too much sugar. So, that’s why it’s so important that people are mindful about how much they’re taking in and make steps to try to reduce and replace with other types of foods and beverages where possible.

Sanjeev Goel, MD, FCFP (PC), CAFCI

When you’re talking about sugar, are you talking about carbs or things that are sweet, like is bread considered sugar in this case?

Nicole Avena, Ph.D

Yes. Yes, so I’m talking about carbohydrates and mostly these simple types of carbohydrates that we can break down, but that we find will be the ones that will give us that energy burst or that rush that we get from not only the glucose that’s being released into our blood, but also from the dopamine surge that comes when we over consume them. And I think that it depends again on the individual. There’s plenty of people who I’ve worked with over the years who could care less about eating ice cream and cookies, but they’ll take a loaf of bread and that’s something that they just have a hard time regulating their intake of. 

So, there really is an individual element to what types of carbohydrates people tend to struggle with. And so when we talk about sugars, I think a lot of people can relate to having a sweet tooth and maybe overdoing it with the sweet sugars. But there’s also plenty of carbohydrates out there that don’t taste sweet, but they actually are detected in our body as if they are sweet, and so we need to keep that in mind.

Sanjeev Goel, MD, FCFP (PC), CAFCI

And they still cause a dopamine hit as well?

Nicole Avena, Ph.D

Absolutely.

Sanjeev Goel, MD, FCFP (PC), CAFCI

The same thing, okay. 

Nicole Avena, Ph.D

It does, yeah. It does.

Sanjeev Goel, MD, FCFP (PC), CAFCI

So, do you think that there’s differences than I guess it doesn’t sound like there’s many differences between different types of sugars? You’re saying that all sugars are equal?

Nicole Avena, Ph.D

Well, we’ve done some research on this and we’ve looked at the role that different sugars have on the brain. And we’ve also looked at some of these alternative sweeteners that are on the market now because as I’m sure you’re well aware, I mean we have a variety of different things in the grocery store now that we can buy to sweeten our foods. It doesn’t have to be sugar or corn syrup anymore. We have a whole bunch of different sweeteners. Some of them are nutritive, some of them are non-nutritive. And so, what we’ve seen in our research is that it’s the sweet taste that seems to elicit dopamine response. 

So, if you are craving sweets and you use Monk fruit instead it’s still gonna release dopamine, even though it might not be as bad for you in terms of calorie content and some other things in terms of how it can impact your blood sugar levels, it’s still releasing dopamine. And so, we would recommend that people try to unsweetened their diet just overall. And so by that, I mean, not opting for these alternative sweeteners just as a way to replace sugar, but work to really cut down on how sweet your diet needs to be. And if you’re going to sweeten it, opt for things like whole fruits. Whole fruits that are naturally sweet they contain fiber and other nutrients. They’re a great way to add a little sweetness to your diet when you need something that’s sweet, but also contains extra nutrients.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Just clarifying that. So if something salty, salty carbohydrates, you don’t have a dopamine hit or you have one?

Nicole Avena, Ph.D

No, we do. We do. So when you have a salting carbohydrate or something doesn’t contain sugar in the sense where it’s a sweet tasting sugar we do see a rise in dopamine, but it’s more indirect. And so, it has more to do with the fact that those types of carbohydrates are increasing blood glucose levels which in turn will raise dopamine levels. And so, when we consume it as sweet carbohydrate it’s more of a direct link to dopamine in the sense that in our rat studies, even if we take sugar and just put it on the tongue of the rat, they don’t even digest it. It still releases dopamine. And so there is this really strong link between that initial taste and the release of dopamine.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Oh, okay. And so you just, you mentioned the artificial sweeteners and I wouldn’t mind if you could just go into that a little bit more detail for our listeners. So yeah, many of them, like let’s say something like Stevia would that have, it would also have I guess you’re saying a dopamine hit, even though it’s probably healthier. Is that correct?

Nicole Avena, Ph.D

It does. That’s correct. That’s what the research tends to suggest that it’s the sweetness that’s resulting in this rush of dopamine. So if you are, let’s just say trying to get off of sugar, I’m certainly would recommend trying one of these alternative sweeteners to replace some of the foods that you love. It’s a way to kind of wean yourself off of actual sugar but I don’t think you should make that the end goal. I think that the end goal should really be to move to the next step, which would be to remove as many of the added sweeteners in our diet as possible. Because if you don’t, you’re still gonna struggle with those cravings. You’re still gonna struggle with the desires to binge and overeat because you’re not actually solving the problem. You’re not allowing your dopamine system to reset. It’s almost like methadone for heroin addicts in the sense that it’s better than heroin but it’s not ideal. I mean, ideally we would wanna be completely off of sugar and sweeteners if we can.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Okay, that makes sense. Thank you. Let me just see here. So can you just… Let’s say you start to cut down that sugar over some time, does your, how you were saying about the dopamine system resetting, can you just tell me what is that happening that, it’s not that easy to release a dopamine anymore? Like what happens to our brain after cutting down the sugar?

Nicole Avena, Ph.D

So, if we are in a situation where we’ve been over-consuming sugar for weeks or months or years even. What’s happening is that our dopamine neurons have become accustomed to this constant surge of dopamine being released into the synapse. And so as a result, we make compensatory changes. Our brains will compensate you for all that excess dopamine by making fewer receptors that are more sensitive. And so, what ends up happening when people decide to cut back on sugar or to reduce their intake of sugar, is that we’re able to go back to this homeostatic set point with respect to dopamine. So when we eat something, it won’t produce this bolus of dopamine being released it will produce a more manageable amount. 

Then we will also see that there’ll be changes in the way in which the receptors are expressed and bound. And so all this basically is a compensatory mechanism to kind of bring us back to where we were prior to overeating sugar and having such a high sugar diet. Now, for many people that point in time was before they were even born, because what we’re finding now, is that so many children are overeating sugar. Even during pregnancy, we are talking a lot about how it’s important to monitor your diet when you’re pregnant because there’s so much research that has been coming out that suggests that that first thousand days of life, is really critical for the development of all the body systems but also for food preferences. 

And I talk a bit about this in my book, “What To Eat When You Want To Get Pregnant”, or excuse me “What To Eat When You Are Pregnant”. And this is really a book that I wrote because I was just fascinated by the research that we were doing and the stuff that was coming out of other labs, linking early life exposure to certain foods and overexposure to sugar, and how it could have a negative impact on the fetus’s brain development and how that has long-term health outcomes for not only immune health, cognitive functioning, but also nutrition status later on.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Wow, so you’re saying that, so it’s not just the first 1000 days of the child’s life, you’re talking about the fetus life as well.

Nicole Avena, Ph.D

Yeah, so the first– Absolutely, the first. Right, the first thousand days of life is generally referred to as the period from conception through age two. And so that covers pregnancy and early life. And so it’s important to consider what is being consumed during pregnancy, but then also when one starts to feed the baby, what types of foods are being introduced? And we’re seeing now more and more toddlers are being overexposed to sugar. I have little kids myself, so I can speak from a parent and know that there are just so many foods on the market that are marketed towards children of that age. And it’s really something that a lot of parents struggle with, especially because kids that age tend to be picky eaters to begin with. And so, it can be tough for a lot of parents to manage.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Yeah, I think they’ve made like Nutella healthy breakfast spread but I find it extremely sweet.

Nicole Avena, Ph.D

Yeah, I haven’t seen that one yet, but I’m sure I wouldn’t be surprised. I think it’s important that people are aware of the marketing and that you have to be very skeptical about the claims that you see on many of the food products because even though it’s organic, or all natural, or has natural ingredients, that doesn’t mean it’s healthy. That means it might have one good thing in it but it could have 50 bad things in it. So, you really need to be very skeptical when it comes to looking at nutrition labels.

Sanjeev Goel, MD, FCFP (PC), CAFCI

So, tell me about your own diet. So, what do you in an ideal world, how much sugar should one have because I mean still some sugar around like you’re saying fruits around. So, how much do you think is like a healthy amount that one should be stimulating our brain with?

Nicole Avena, Ph.D

Well, I think that there’s a lot to think about when we try to answer that question. So, I think the less the better, and I think not so much how much we should have but what are the sources that we should draw from. And so, I think opting for fruits, those are great, but we wanna make sure we’re not opting for fruit juice because that’s just essentially the sugar sucked out of the fruit and all the nutrients left behind. So whole fruits are very good, even if they’re frozen, they’re still good. We wanna avoid dried fruits, or dehydrated fruits, because again, often they’re devoid of the nutrients due to the dehydration process. 

So, a whole fleshy fruit is really the ideal way to go and the best thing. But I mean, I think that for most people there is room to have sweets now and then. I think that we can have them on occasion but I just think that we need to be more mindful of how often now and then is, because what we’re seeing is that, it’s somebody’s birthday at school every day, and so the kids are having a cupcake every day. And, there’s just a lot of opportunities for sweets to be introduced. Whereas they’re not occasional special things anymore. They’re a regular part of our diet and I think that’s where we need to kind of be mindful and pay attention to when we might be having too much so that we can think about cutting back. 

But in the U.S. I mean, we have guidelines now that suggest that no more than 10% of the daily calories come from added sugars it was recommended that that number be reduced to 6%. Although for some reason, that’s still not clear those recommendations were not adopted in the latest iteration of the nutrition guidelines. But, I would agree that aiming for five or 6% of your daily calories coming from added sugar would be ideal. And I think that for most people, you’re probably way over that even if you think you’re not eating any sugar, because there’s sugar hidden in so many of the foods that we eat. That even if you’re eating as healthy and clean as you possibly could, I guarantee you’re still eating sugar.

Sanjeev Goel, MD, FCFP (PC), CAFCI

So what do you think about, like Keto diets or extreme low carb diets? Like a hundred grams a day of carbs? What do you think about that?

Nicole Avena, Ph.D

I think there’s a place for them. I think that they need to be done mindfully. My concern about diets like that where it’s extremely low carb, is that people will then make choices that are high in saturated fat or high in other forms of fats that are not good for our health either. And so, I think that if people adopt a low carbohydrate lifestyle it’s a great thing. But, I think it needs to be done with careful attention to the sources of other types of foods that people are supplementing with their new diet. 

You see these advertisements for Keto and people will talk about how, oh, they eat all the bacon they want and it’s a greatest diet ever, that part of it I’m not really on board with because we know that there’s health risks associated with eating too much saturated fat, that are just as serious as the health risks is eating too much carbohydrates. And so, I think it really just needs to be done in balanced but if people can incorporate healthy proteins and healthy forms of fat into their diet and do it in a low carbohydrate manner, then I think it can be beneficial. And a lot of people who eat that way are able to lose a significant amount of weight and keep it off, and they’re also able to see that a lot of their chronic conditions seem to dissipate and get better. And so, I think it can be an advantageous type of diet for people if they do it the right way.

Sanjeev Goel, MD, FCFP (PC), CAFCI

What’s your advice to somebody who saying, okay, look I want to do the sugar detox. Like, what timeline should they expect? Before they feel like, okay they’re gonna be successful and that’s gonna be a lasting change.

Nicole Avena, Ph.D

Yeah, so I think you have to be kind to yourself and give yourself time, and realize when you do something for months or years, it’s not necessarily gonna go away the minute you decide to make a change. But, if you do decide that you’re gonna cut back on your added sugar and try to cut it out, you can expect that you’re gonna have some uncomfortable feelings in the first week or two. Most people experienced some mild form of withdrawal where they’ll feel like they have a headache or they’ll feel lethargic. A lot of the times you’ll hear people around like the middle of January, who’ve maybe decided to cut out sugar for January as a new year resolution that midway through the month, they start to feel like, oh, I don’t know my blood sugar is dropping I think, ’cause I’m weak and I’m tired. Well, that’s actually not the case. Your blood sugars just fine. 

The reason you feel like that is because you’re in withdrawal, and that’s the symptoms of withdrawal when it comes to sugar; irritability, fatigue, feeling just like not yourself. And so, depending on the severity of the addiction that can last for a couple of days or can maybe last for even up to two weeks. But, by and large, most people after two weeks they start to feel like they’re on the other side of it. They don’t feel as terrible as they typically would in the beginning days of giving up sugar. And, I think then that’s when the challenge comes into helping to navigate through this new world of no added sugar. How do you go to the office, and if it’s somebody retirement party, how do you say no to having that piece of cake if you just don’t wanna have it? And so that’s where–

Sanjeev Goel, MD, FCFP (PC), CAFCI

What do you suggest? What do you suggest?

Nicole Avena, Ph.D

It’s well I think…I suggest people have a whole stock list of excuses that they can bring up. And so, this is something again I talk a lot about in the book, “Why Diets Fail” because the psychology of it is just as important. So, if you tell somebody, oh, I just had a piece of cake for lunch. Like, lie if you have to. I mean it’s really your health and you’re the person who’s in charge of it. And, people tend to sometimes feel bullied into eating certain foods, believe it or not. And I think that you need to be in control of that. And I try to work through many of the different ways in which you can prepare yourself for some of these awkward social interactions, so that you have something prepared to say, so it doesn’t make you feel uncomfortable.

Sanjeev Goel, MD, FCFP (PC), CAFCI

What do you suggest people do with regards to like avoiding the triggers? Like I see you’re saying like obviously if someone’s brought it as a birthday party that’s a kind of potentially be a trigger. But, what other ways can they do to kind of reduce the triggers to this addiction?

Nicole Avena, Ph.D

Well, part of the reduction of the triggers or the effects of the triggers have, begins with recognizing the triggers. And I think that’s usually the most difficult part for people is that they don’t always know what’s triggering them, and what’s causing them to overeat. So, a lot of times let’s just say somebody has a bad day at work and they have a long commute home and they finally get home, and the first thing they do is grab a bunch of cookies and stick them in their mouth. And, they don’t necessarily equate that to the fact that they had a bad day at work and they were anxious and now they’re using the cookies to self-soothe and to self-medicate to help them feel better. 

And so, when people start to reflect and look back at the situations in which they overate or gave into the sugar urge when they didn’t want to, you really can start to see the pieces fall into place, so that you can better understand where you might intervene. And so ,if you had a bad day at work, you wanna recognize that and recognize that’s making you upset and anxious. And so, maybe instead of going in the kitchen when you get home, you’re not even gonna go in your house you’re gonna walk around the block twice to just burn off the tension and distract yourself from the fact that you’d love to just go in and grab a bunch of cookies. And so, figuring out how you can sort of break up these relationships and sort of untrigger the triggers is really key. 

And, a lot of social situations like you suggest with the birthday party, if that’s a trigger, what I suggest is that people be prepared for that trigger. And so, you need to have your bulletproof vest. You need to come to that party with a nice plate of fruit that you’ve prepared as the alternative dessert that the people who aren’t having cake can enjoy. And so, thinking through these situations and how can you circumnavigate them in a way that’s still gonna allow you to participate and feel like you’re involved, but doing it in a way that’s best for your health and best for the health of the people around you.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Yeah, we use the birthday watermelon at our place. It’s become a tradition , and that, and I use the I’m allergic to cake as my excuse.

Nicole Avena, Ph.D

That’s perfect.

Sanjeev Goel, MD, FCFP (PC), CAFCI

What do you use as your… What advice would you give to somebody who’s trying to help somebody else with coming off sugar?

Nicole Avena, Ph.D

Yeah, that can be difficult. That can be a tough one because, it often takes a support of a whole family. And especially if you live in a family where people have different dietary interests and needs then if one person is trying to get off of sugar and the rest of the family isn’t on board with it. 

They might not be okay with not buying cookies and ice cream and things like that at the store. And so, I think it’s important that we’d be mindful of the health of others in our family. And if somebody is trying to do this, we really need to give them as much support as we can because it certainly is an uphill battle especially in our modern food environment where people are constantly being bombarded with advertisements and options to eat these foods that they’re trying to avoid. I often talk about how, for people who are addicted to drugs like heroin, for example, fortunately for them there aren’t like billboards of heroin needles. And there aren’t magazine, advertisements, and internet popups every two minutes with a picture of heroin paraphernalia. That would be awful because these poor people are trying to avoid all those triggers. But, all of these people who are trying to reduce their addiction to sugar are constantly fighting these triggers day in and day out. 

So, if you are trying to help somebody through this, I think being a supportive ear, helping to get them to a place where they can take baby steps it’s not something that has to happen overnight. You don’t have to wake up and quit sugar. I actually advise against that when I talk about this in “Why Diets Fail”, because when you quit sugar cold turkey, it’s often setting you up for failure because it’s just so much, it’s like taking on way too much. The sugar in so many parts of our life. 

And you really need to, I suggest do more of a baby step approach of a harm reduction approach, where you start off by finding the single source of the most added sugar in your diet. For most people, that’s sugar sweetened beverages, like sodas and Cola’s and things like that, and work to reduce them and replace them with something else. So, if you were a big soda drinker maybe you decide, okay, well, I drink the soda because I like the caffeine buzz that I get, I need that caffeine throughout the day. Okay, so switch to coffee, switch to black coffee that’s can be your substitute. And if you drink the soda because you like the bubbles or the fizz, well, there’s plenty of sparkling waters on the market now that are zero calories, zero sugar, and taste delicious, and they’re still so much healthier. So, it’s really just about identifying what it is you like about certain foods and then just making little tweaks and replacing them. And over time, you’ll come to not miss those foods. When you see the benefits you’re getting from the replacements.

Sanjeev Goel, MD, FCFP (PC), CAFCI

You know, I find that so interesting about the starting to it like be aware of how people are pushing sugar. I noticed that at the fast food places, it’s almost, it’s like a normal part of asking, do you wanna have a combo? Which I think always comes with a drink.

Nicole Avena, Ph.D

Yes.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Do you like, do you… Can you just tell our viewers a little bit about how much sugar content is in these drinks compared to let’s say, I don’t know, orange or something like. What–

Nicole Avena, Ph.D

Oh, my goodness, I mean–

Sanjeev Goel, MD, FCFP (PC), CAFCI

What are you talking about, how much sugar?

Nicole Avena, Ph.D

Depending on the venue that we’re talking about. I mean, these types of sugary drinks we’re talking hundreds of, maybe even a thousand times more sugar than what you’d see in like a Clementine or a handful of grapes. And we’re talking about an excessive amount of sugar and it’s not being consumed in a way that is allowing it to be absorbed in the body properly. So, when we eat fruit that contains sugar, it also contains fiber and other nutrients that actually allow that sugar that we consume to be slowly dissipated into our body and absorbed in a way that’s gonna be beneficial. But when we eat a Snickers bar, that’s not what happens. 

We’re having this sort of bolus of sugar that we’re consuming and it’s gonna cause this abrupt increase in blood glucose levels. That’s gonna cause changes in our insulin levels. It’s gonna cause that spike in dopamine. And so, it’s really important that people are aware of how much sugar is in many of the products that are out there and what it’s doing to us. I have the lecture where I teach at Princeton University, and the lecture that I give when I talk about food and nutrition in the health psychology class that I teach, I put up a bunch of slides of different food products and I asked the students to guess what percentage of their daily value of added sugar do they think is in the food products? 

And many of them are things that you would expect to be high in sugar, like frappuccinos and cinnamon buns, but many of them are actually healthy looking products like yogurts, for example, and they contain a full day’s worth of sugar one serving, which is really, really, really not good. And so we need to keep that in mind, it’s very easy to not even leave your house in the morning and have already consumed the daily recommended amount of added sugar just by it passively being absorbed into us through foods that we simply think of as healthy but they actually contain a lot of added sugar.

Sanjeev Goel, MD, FCFP (PC), CAFCI

So, how many grams is that? Just so I can get understanding, you said it was like 10% is the recommended guideline of a calories from added sugar? but what is the–

Nicole Avena, Ph.D

Yes.

Sanjeev Goel, MD, FCFP (PC), CAFCI

What’s the amount to this–? So– So, it’s about–

Nicole Avena, Ph.D

Yeah, so about 10 to 12 teaspoons is what is recommended per day. And so, depending on when you look at the label if you’re trying to understand, if this is a a good product to buy or a bad product to buy I often recommend looking at the label and seeing what is the percentage of added sugar. And if it’s over 10%, then I would avoid it. And also you wanna take a look at the ingredients list, and if you see any form of sugar in the first five ingredients, then I would avoid it. Because those ingredients are listed in order of how much they’re used in the product. So the product, if it’s got sugar listed as the first ingredient that means the product is mostly made up of sugar.

Sanjeev Goel, MD, FCFP (PC), CAFCI

So is there a dose response of between like blood glucose levels and dopamine release, like cause, so you’re saying that if something causes blood glucose to go up quicker does that mean greater spike of dopamine?

Nicole Avena, Ph.D

Yeah, there have been studies that have shown that there is a link between how high the blood sugar spikes and dopamine release. And, obviously that’s gonna be somewhat of an inverted U because when glucose levels go too high it’s gonna be aversive. and that’s the case when people go into diabetic shock. 

And so in that case, we’re not gonna see dopamine rising, it’s actually gonna be falling because it’s gotten to the point where it’s now aversive. But we do see that this happens, and that’s in part, one of the reasons why a lot of candies and foods that contain a lot of excess sugar in a small volume can make, kids especially, feel really good and can taste delicious because they are able to produce this spike in dopamine. That’s not like what we get when we eat strawberries or blueberries or a fruit or some other thing that contains sugar but just in a less amount.

Sanjeev Goel, MD, FCFP (PC), CAFCI

This, your latest book, “What To Eat When You Want To Get Pregnant” is about reproductive health, can sugar have impact on fertility?

Nicole Avena, Ph.D

It can. It absolutely can. And we’re seeing this coming from a couple of different sides of the story. And so, there’s been some work over the years obviously that has linked being overweight and obese with infertility. And people who tend to be overweight or obese often will sometimes struggle with infertility issues, more so than people who are normal weight. And, so it can be a risk factor for infertility. But, we’re also seeing it from the standpoint of the fact that on a cellular low level, there seems to be a link between overeating sugar and decreased immune response. And so, that in turn can have an impact on our fertility as well when our immune system is being compromised. 

If you think about it from an evolutionary standpoint, if your immune system is compromised it’s probably not a good idea to get pregnant and have a baby, right? Because if your immune system can’t even take care of yourself, how’s it gonna take care of a growing fetus? And so this can be another risk factor that can cause this sort of secondary infertility as a result, that we need to be mindful of. And, I talk a lot about this in my new book “What To Eat When You Want To Get Pregnant”. And, I think that it’s important for people who are actively trying to get pregnant, trying to conceive, but also people who are maybe thinking in a couple of years they might wanna have a baby, both men and women.

 It’s so important that we pay attention to nutrition because what you eat can have a significant impact not only on your health, but your fertile health as well. And so, knowing that many of the foods that we commonly eat contain these added sugars which are not good for fertility. And also, contain other ingredients and chemicals and pesticides and things that we know can have a negative impact on fertility, I think is so important. And, we need to get ahead of it because it’s not gonna happen overnight. You can clean up your diet but some of these chemicals and these pesticides are gonna be residues that are gonna take a little while for us to shed. And so, I think the earlier you can start thinking about your diet and making some changes, all the better.

Sanjeev Goel, MD, FCFP (PC), CAFCI

So, just to try to understand a little bit the mechanism what do you understand, what do you think is the mechanism between sugar and decreased immune system? Do we know?

Nicole Avena, Ph.D

Well, we’re hearing more and more about this, especially with everything that’s happening with the COVID pandemic. And, the fact that we’re seeing so many individuals who are having to be hospitalized and having serious disease complications, and having that be associated with being overweight or obese. And so, that is a significant risk factor for developing complications from COVID. And we knew that–

Sanjeev Goel, MD, FCFP (PC), CAFCI

Things like more inflammation or something. They tend to have more inflammation.

Nicole Avena, Ph.D

Exactly, and sugar is an inflammatory, right? And we can show that when people consume sugar it serves as something that causes inflammation. And so I think, we’re still working out the exact mechanisms of how it decreases the immune system and compromises it. But I would imagine that it’s through that mechanism of the fact that it is causing inflation, and perhaps some way that is disrupting normal immune system health and response. Which as a result, puts people in a situation where they are unable to fight off some of these types of pathogens and viruses that normally we could, if our immune systems were up and running correctly.

Sanjeev Goel, MD, FCFP (PC), CAFCI

So, what are your thoughts about sugar and like the long-term impact on the brain of being addicted to sugar? Like I understand, and also what are your thoughts about sugar and like Alzheimer’s? I heard that there’s some connection with that as well. So, I’d love to hear your thoughts on that.

Nicole Avena, Ph.D

Yeah, so I think long-term, the effect that sugar can have on the brain. I mean, we talk about this from, I think the standpoint of just mental health and physical health. And so, I think that we need to keep in mind that there’s two situations that are happening here when people are struggling with a sugar addiction for many, many years and they’re in this sort of vicious cycle of not being able to get out of it. It takes a significant toll on people’s mental health. It can cause anxiety, can cause depression, and many people find themselves in this spiral of distress where they’re depressed and anxious about the fact that they’re addicted to food and they can’t change their dietary habits. And so, it can really lead to poor mental health outcomes and that can prolong and in persist for many, many years, and we certainly don’t want that to happen. 

But then on the physical side of it, I think that we need to keep in mind that the longer people struggle with sugar addiction the longer that they’re more likely to develop obesity and being overweight and those comorbid health conditions like metabolic syndrome, cardiovascular disease, diabetes, and these are conditions that don’t appear overnight. You usually see these things emerging after years of use. And by that time, it can be very difficult to reverse some of the behaviors that perhaps got a person into that position. And so if, when I speak with parents about this and try to help families who are trying to maybe change their child’s diet or get their family diet under control. 

I often say, just because your children are lean, and active, and look healthy right now, it doesn’t mean that they’re gonna be like that in 10 years. And when they’re in their twenties or late teens, they might develop some of these chronic conditions because of the diet that they’re consuming. And, you could treat those chronic conditions with medications for the rest of their life, but you’re still gonna have those behaviors that are not so easily unlearned. And so that’s why it’s so important from a very young age to try to get kids on board with eating healthy and understanding why. It’s not about how you look today, it’s about how you’re gonna live 10 years from now. And with respect to your question about the links to Alzheimer’s disease. Yes, I think that certainly there’s a lot of research that’s coming out now that suggests that sugar does play a significant role. 

I think we’re gonna be hearing more and more about this. I’ve seen several articles that are restarting to refer to Alzheimer’s disease as a form of type 3 diabetes in fact, because there seems to be such a strong link between diabetes, and sugar, and Alzheimer’s disease. So, I think that’s something we’ll see more information about over the years, especially as we’re getting to the point where many of the baby boomers are of that age where they’re going to start to be diagnosed with Alzheimer’s disease and they’re living to that point. And so, I think this will be a bigger issue and we’ll be hearing a lot more about it in the coming years.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Thank you. That’s great. Is there anything else you want to tell our viewers about sugar and addiction? I need like, like what’s the main message that they should take away from today?

Nicole Avena, Ph.D

I think the main message that people should take away from today’s discussion is really that sugar addiction is something that we now have science behind. We know that this is real. We know that this is a phenomenon that people struggle with. It’s a biological condition. We have tons of evidence that backs that up. And so, I think that the point that people who feel like they’re struggling with sugar addiction should walk away with is knowing that this is a condition that has affected your brain to make you want to behave a certain way. And so the punishment, the self-doubt, the guilt, all that should just be left at the door and you should focus on what you need to do to correct it. And there’s lots of resources out there. Lots of information. If you go to my website, drnicoleavena.com, I have lots of links to articles and information about the latest research on sugar addiction, really to help people to make those changes and make those adjustments they need to, to their lifestyle, so that they can break free from it.

Sanjeev Goel, MD, FCFP (PC), CAFCI

And just, if you don’t mind, just letting the viewers know about your books, “Hedonic Eating” and the book for, “What Eat When You Want To Get Pregnant”,

Nicole Avena, Ph.D

Yes.

Sanjeev Goel, MD, FCFP (PC), CAFCI

And the one about I’m sure children. What, if you wanna just mention them quickly?

Nicole Avena, Ph.D

Yeah, absolutely.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Thank you.

Nicole Avena, Ph.D

So, my newest book “What Eat When You Want To Get Pregnant”, this one will be out in stores, online, available all over April 1st. And then I’ve got a couple others, “Why Diets Fail”, this is all about sugar addiction. So, if you’re interested in learning about tips on how to cut sugar out of your diet, how to replace it, or just learning more about the science behind sugar addiction, definitely check this out. And then the last two, “What To Eat When You Are Pregnant” this is really meant for moms who are pregnant and wanna use nutrition to their advantage, to grow a healthy baby. And then lastly, is “What To Feed Your Baby And Toddler”, and this is really a handbook for new parents to just navigate that world of introducing solids to your baby. And, it’s based off of the latest research that suggests that we essentially should not lead with fruit. We tend to think, when I know when my almost teen was a baby and it was time to feed her, the doctor said to me, okay, start with apples and then do pears, but that’s actually not a good idea. And I go through the research in here, why we wanna lead with vegetables. And, I kind of navigate the whole having a kid, and trying to get sugar out of their diet from the point of being a toddler on.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Okay, awesome. So what are just, I’m curious before we end off, what’s your interest? What are you looking at right now, is unanswered question your research, like what’s exciting you right now that you’re working on?

Nicole Avena, Ph.D

Yeah, so right now, we’ve been really focused on trying to just get a better understanding of which foods are addictive. And so, I think for years and years we’ve worked to establish whether or not food can be addictive. And, I feel like we’re finally at that point that most are in agreement that there’s sufficient evidence that sugar and other types of probably processed foods can produce signs of addiction. But I think now it comes the question of, okay, well there’s shades of gray. Like, is this healthy looking granola bar that costs $5, is that okay to eat or is that added sugar? So, I think that’s where we are now is to try to better understand what are the properties that we wanna look for when trying to decide whether or not a food is gonna produce an excess amount of sugar or if it’s something that we should be thinking is like more of a healthy type of food. And so, that’s really where we are now in terms of the research, trying to catalog that and figure out a way to better advise people on what foods are falling on the healthy side of the spectrum versus maybe the unhealthy side.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Yeah, okay, perfect. That’s really exciting. So, thank you so much, Dr.Avena. I really appreciate your time today.

Nicole Avena, Ph.D

Oh, thank you. Happy to be here.

Sanjeev Goel, MD, FCFP (PC), CAFCI

Okay, so you’ve been listening to the Dr. Nicole Avena at the Advanced Antiaging Technology Summit. Hope you enjoyed the session today.