What do mobile phone charms and obesity have in common? Besides their ubiquity, one might argue they are the result of a system that gets products into the hands of consumers (fast!): Capitalism.

Critics of capitalism contend that obesity (and phone charms) exemplify all the flaws of system built to cater to our immediate desires. Yet, in order to illustrate how right trusting capitalism is to solve obesity, I beseech the aid of Mr. Jamster (the ringtone master), to show how free systems actually extinguish horrible ideas, fast. Fads come and go, and in free systems the speed of fads seems to be intensified with a special kind of velocity. If you don’t believe me, please go have a peak at street wear in Pyongyang. That’s not a deep sense of sartorial irony: those jeans are for real.

Perhaps a better way of framing ‘speedy trends’ is to draw parallels with ‘effective adaptation,’ – but we’ll save the science-y parts for later. Ringtones have been discarded by the masses because they are naff and ridiculous. How can we eschew stupid things like ringtones so quickly, but cling to ding dongs and hot dogs with such…silliness? Here I will explain why I think capitalist forces might actually provide the most efficient alternative to solving the Obesity Crisis, as opposed to the alternative (i.e. More Rules and Boring Regulations).

How Did We Get Here?

100,000,000 years of being in a state close to starvation has honed our taste buds to sense energy. Quickly. This preference for high calorie food is related to the immediate pleasure we experience when we put it in our mouths, more energy allows us to survive for longer. The feel-good response is nature’s way of ensuring that we will continue to repeat this kind of behaviour. A jillion years ago in the Sahara, finding a lot of energy was a really big problem: whereas today, with pizza covered in chocolate sauce (or whatever) on every street corner, we face the reverse issue. And trying to undo or change habits that are 100,000,000 years in the making is a tough task indeed.

The pleasure factor associated with eating has forged a path – some might say ingeniously- for a food logistics system that allows us to eat whenever and wherever we want. We enjoy eating. Being hungry is painful. Erego, having access to food is very pleasant and thus we have created a system that allows us to eat at all times.  The seamy underbelly of this elegant distribution network, is that a lot of the food that ‘feels’ good is really really high in calories. It may even cause inflammation. Gross.

Determining why we prefer ding dongs to broccoli provokes a series of interesting follow up questions related to the brain and how pleasure is experienced. When we eat delicious food, the limbic system (where pleasure centers reside) kind of claps for joy. This system works in tandem with the ‘planning’ part of the brain (or it should). Sometimes the rush of hormones we experience with nice tasting food (and the memories we have for these tastes) outweigh our long term thoughts about whether our trousers will fit tomorrow.

A brief summary:

1. Chocolate in mouth= A rush of feel good hormones (like dopamine, something that is associated with the ingestion of cocaine)
2. Next we feel intense pleasure, until it subsides
3. We remember the pleasure, the product, and the place where we found it

So. You cannot hide cookies from yourself: They will always taste great, and you will always remember they’re on top of the fridge. Sorry.

Where to Next?
Obesity demonstrates that we are suckers for feeling good. In order to solve this universal pandemic, shouldn’t we appoint a strategy that uses the same kind of artillery that got us here in the first place? Feeling good? Sanctimony doesn’t equate to Feeling Good, at least not for me… I don’t think you particularly enjoy feeling shamed, either. This may explain why certain public health campaigns haven’t had lasting effects: a lot of the time, they are thinly veiled Glib Fests.

Science has shown that being told to diet only provokes more hunger. With this important information, we started an anti-dieting fad that has done absolutely nothing to solve obesity. Unfortunatley this fad isn’t dying as quickly as ring tones, because we like to trick ourselves into believing that what we’d like to eat is what our bodies ‘need’.

With every ‘eat how you please’ message broadcast, another fifteen pounds is dropped upon someone, unwittingly. The truth of the matter, is that overeating leads to more overeating. This can be backed up with hundreds of studies looking into neurotransmission and dopamine function. A funny thing, though- starving yourself (and by ‘starve’ I mean, feel hunger pangs for a day) actually leads to an increase in pleasure receptors in the brain, which means you’ll need to eat less to feel the same kind of satisfaction.

So how should one change their eating habits without thinking about it??

Humor can be a great way to change your thoughts about food. If you pause long enough to sit back and laugh at how silly it is to cry with a container of ice cream by the television, you might start to see a path towards redemption. Seeing people in gym kits and telling you to ‘Just Do It’, may lead to another session on the couch. With sprinkles on top.

Something Else To Do

Here is where science can helpful. The same kinds of feel good hormones can be exploited by a variety of activities. New activities, learning a new language, engaging in vigorous exercise, sex (!) all elicit the same kinds of feel good hormones as a chocolate bar. What’s stopping you from a new taking a new class, or planning some kind of adventure? Environmental change shakes up the brain, and it also can make you feel great. So switching up your daily walk to work (or evendrive to work) can spark new kinds of thoughts and thinking.

By the forces of capitalism we will have calorie free chocolates and French fries (and maybe even soon!). Until then, my advise would be to embrace the other areas of consumerism where capitalism has shown its adaptive muscle: download some music, or maybe even some stand up comedy in order to avoid terrible food (the better your mood, the less likely you are to engage in the bad kind of emotional eating). My experience has also told me that a lot of ‘bad’ eating habits happen privately, at home. Use your computer or phone to distract yourself: there are so many other ways to make yourself feel better than running to Baskin & Robbins.

The food industry responds to what we buy: when we stop buying junk food, they’ll stop making it. Doesn’t this seem like a more logical way towards reform?

Of course, this is not the end of the story. Two distinct and important problems that effect the ‘freedom’ of the food market include broad areas as

- Why junk food is so cheap, and

- Why the Poorest People Have Access to (perhaps) the Worst Foods Ever.

However, blaming the food industry for creating nice tasting food is about as logical as getting angry with farmers for making vegetables taste too bitter. If markets were allowed to function, and we behaved in a way we’d like to believe we do, obesity wouldn’t be an issue.

…Wouldn’t it be healthier- and more adaptive- to accept the our inner heathen,  and incorporate him (her!) into a solution?

1. Volkow, N. D., Wang, G. J., Fowler, J. S., & Telang, F. (2008). Overlapping neuronal circuits in addiction and obesity: evidence of systems pathology. Philos Trans R Soc Lond B Biol Sci, 363(1507), 3191-3200.

1. Volkow, N. D., Wang, G. J., & Baler, R. D. (2011). Reward, dopamine and the control of food intake: implications for obesity. Trends Cogn Sci, 15(1), 37-46.

1. Volkow, N. D., Fowler, J. S., & Wang, G. J. (2004). The addicted human brain viewed in the light of imaging studies: brain circuits and treatment strategies. Neuropharmacology, 47 Suppl 1, 3-13.

1. Wang, G. J., Volkow, N. D., Logan, J., Pappas, N. R., Wong, C. T., Zhu, W., et al. (2001). Brain dopamine and obesity. Lancet, 357(9253), 354-357.

1. Thanos, P. K., Michaelides, M., Piyis, Y. K., Wang, G. J., & Volkow, N. D. (2008). Food restriction markedly increases dopamine D2 receptor (D2R) in a rat model of obesity as assessed with in-vivo muPET imaging ([11C] raclopride) and in-vitro ([3H] spiperone) autoradiography. Synapse, 62(1), 50-61.

The psychoactive effects of chocolate…

Paradoxically, it seems that eating dark chocolate is one of the pillars of Dieting Success. Espoused by world-renowned experts ranging from Kylie Minogue to Sofia Vargara, including ‘one or two squares of dark chocolate’ is fundamental in avoiding food ‘cravings’.

OK then.

A few of my other heroes, the ones required to showcase their brains as opposed to bodies as professional wares, (i.e. academic psychologists), also spend time on the role chocolate plays in our diet. Researchers at Drexel recently published a paper that caught my attention:  ‘Psychoactive effects of tasting chocolate and desire for more chocolate’. It’s published in a place with a slightly higher pedigree than say, Hello! magazine, so I’m a little more inclined to believe what they have to say about this miracle food. The theme of course, is whether chocolate could be considered addictive.

In, ‘The Psychoactive Effects of Chocolate…’ researchers consider how chocolate might be likened to actual drugs of abuse. Who ever knew the gritty sides of scientific investigations could be so… interesting?

Were you ever curious about how academic researchers might work the phrase ‘Speedballs’ and Lindt chocolate into the same article? Or, rather, how speedballs might share sensory qualities with things like Maltesers and Aero bars?

Until now, you may have missed out on this exciting intersection of ideas. In trying to understand why too much chocolate is so treacherous for our thighs, we may have to consider our compelling desire to eat too much. As we inch towards the most romantic binge of the year, February 14, this becomes an increasingly important issue. So… why would dark chocolate enhance dieting, and milk chocolate lead to tears by the television? I’ll try and disentangle that today.

The consumption of fat and sugar (key components of chocolate) activates multiple neurotransmitter systems, including a release of dopamine and endogenous opioids. More specifically:

1. Eating sugar and fat means an increase of both dopamine and endogenous opioids (i.e. ‘endorphins’) in really sensitive areas in the brain occurs.
2. Eating sugar/fat means more Dopamine is released into the midbrain, cingulated cortex, hippocampus, nucleus accumbens, locus ceruleus
3. Eating sugar/fat means increases gene expression of endogenous opioids in the arcuate nucleus of the hypothalamus

The key is that both dopamine and opioid systems are stimulated at the same time. Do you know what else can stimulate opioid and dopamine systems at the same time?

Speedballs!

I had no idea about this narcotic cocktail until I read the paper this morning, and I thought I’d share a few key quotes:

‘..Dopamine-Opioid combinations are commonly referred to as ‘Speedballs,’… ‘Activating dopamine and opioid systems at the same time is akin to the pharmacodynamic effects exerted by combinations of dopamine agonists (amphetamines and cocaine) and opioid agonists (morphine and heroine).‘

And, just so we’re all clear on what speedballs do:

 ‘Speedballs are more reinforcing than either dopamine or opioid agonists on their own…’

(i.e. either cocaine or morphine or heroine on their own don’t compare to Speedballs).

‘As a mixture of fat and sugar, chocolate could activate both dopaminergic and opioidergic systems…’

So, eating chocolate is like taking Speedballs?

Is this journal article about m&m’s, or a recap from an episode of The Wire?

Eventually, the study showed that the combination between sugar, fat, and the ‘drug-like effects’ contribute to how much a person will want to eat. We see that 70% and 85% cocoa content elicited the greatest ‘craving’- in men!

And yet, and yet… Here is where the story falls apart. Can we be honest about chocolate consumption? What man has ‘chocolate problems’? Especially dark chocolate problems? In all of my life of food and ingestive behaviour research, not once have I met a chocolate addict who couldn’t stop eating dark chocolate. And I have never met a man who was wrought with guilt after eating some milk chocolate buttons (or smarties). Guilt is a key sign of addiction, after all.

A chocolate addict is almost certainly a woman, and it’s almost always milk chocolate that elicits overeating. Those lucky ladies who claim their ‘one square of dark chocolate a day’ are almost a different species from people with chocolate addiction. Someone who genuinely likes dark chocolate is unlikely to have ever had an issue with chocolate addiction in the first place: if you have a high tolerance for bitter tasting foods (like dark chocolate) it’s unlikely the milk chocolate will have the same kind of stunningly rewarding effect. So those people who claim their one square of Lindt extra dark a day is keeping them on the straight and narrow path of dietary restraint are unlikely to have ever really suffered with the issue of overeating milk chocolate and those foods that are ultra high in fat and sugar in the first place.

…Something seems to be amiss.

Although, maybe not. In fact, all of this makes me think that there might be yet another parallel between drugs/food issue beyond neurotransmission. Like Speedballs, the admission of chocolate craving is so shameful that women are willing to lie in blind investigations about how much they’d like to eat more of it.

…Doesn’t that sound a bit more likely?

My advice, for what it’s worth, is to avoid the chocolate entirely at Valentine’s. Except for maybe the dark stuff… and, there may be better ways to elicit dopamine even still… (wink!) more on that next week.

Dr.yL

Please see:

(Nasser et al., 2011)

Nasser, J. A., Bradley, L. E., Leitzsch, J. B., Chohan, O., Fasulo, K., Haller, J., et al. (2011). Psychoactive effects of tasting chocolate and desire for more chocolate. Physiol Behav, 104(1), 117-121.

Today, I am describing what ‘addictive behaviour’ really is, and how we can understand this in the context of eating and dieting behaviour. A timely lesson, I thought, given the time of year and our pressing need to forget all of that chocolate.

A recent article titled, ‘Food scarcity, neuroadaptations, and the pathogenic potential of dieting in an unnatural ecology: binge eating and drug abuse’ has led me to consider whether or not, as authors suggest, dieting can cause the same changes to the brain as during the course of the development of addiction.

An important point here is to understand of what ‘addiction’ is actually comprised. Addiction is a slippery concept. Are habits addictions? Are people with OCD secretly ‘addicted’ to their checking behaviours? Is my 14 hour work out week a secret dependency?

Addiction occurs when you favor one behavior in place of any other activity. One could call a strong commitment to one’s work life an ‘addiction’. Yet here lies a critical line in the sand: addiction will absolutely destroy your life. While workaholism may be a contentious issue, it usually brings in a pay cheque. So here is the litmus test: does the behaviour enhance your life? One could hardly say that drugs are life enhancing. The rapid changes that they induce in the brain further emphasize their utter futile role for a happy or productive life

How Do Drugs/ Pleasant Things Cause Addiction?

Individual susceptibility to addiction is still uncharted territory. We don’t know who will become addicted until it’s too late. This is yet another reason to stay away from drugs.

Step 1: Pleasure and Primary Rewards

The course of addiction can be described as a process that follows like this: you flood the brain with so much feel good hormone (dopamine), you experience euphoria.

Critically, this feel good hormone can be exploited in a variety of ways. Drinking when thirsty. Eating when hungry. Sex. Sleeping. The feel of a hot shower. Coming in from the cold. Those are all ‘primary rewards’ since they all enhance our likelihood of living for longer. Scientist use the term ‘hijacking of the reward system’ to refer to external sources of pleasure that do nothing for our survival, such as taking drugs, pornography, shopping addictions, gambling addictions.

Step 2: Remember

Over a few repetitions with the drug, you begin to encode (remember) the place, time, and feelings that you had before you ingested it. Over time, these cues begin to acquire a certain familiarity. They adopt a kind of Pavolvian hold over you: you begin to have ‘cravings’ perhaps when you didn’t want to, coincidentally around the neighbourhood of your dealer or hearing certain songs, or even certain smells that you incurred whilst you took the drug.

Step 3: Changes to Plasticity

The process I have described is seated in biological and physiological changes in the brain. We say there is a change to plasticity, because the brain can actually adapt to a variety of circumstance. When you flood your brain with dopamine, you engage in a lot of excitatory activity in the limbic system (ventral tegmental area, Nucleus Accumbens). Over time, the receptors to absorb the dopamine get tired. So they die. What you are doing, is killing off the most sensitive and important pleasure sensors in your head, and when you try the drug of choice again, its rewarding properties are intensely pleasurable, because you have fewer receptors to absorb all the excess dopamine.

Step 4: Addiction:

So, the more you do drugs, the most intensely pleasant they are, but this pleasurable activity lasts for a shorter and shorter time until eventually it isn’t nice feeling. You may need to do this to feel ‘normal’. You will also be more susceptible to the predictive cues associated with the drug, those things that reminded you of taking drugs, and this is beyond cognitive control.

No addict ‘wants’ to feel cravings (which could be considered physically painful, in addition to being psychologically disastrous), yet they persist. The cravings persist long after a person has been sober- people can fall into the throws of addictive behaviour months or even years of being ‘clean’.

What does this have to do with food? Or eating?

First, food that is high in sugar and fat elicits the release of endogenous opioids and dopamine. These are the feel good hormones implicated in addiction.

Second, the binge-purge cycle of dieting smacks ever so closely of the kind of behavioural pattern that addicts engage in. It’s one thing to have a few chocolates ever day. It’s another to eat bags of cookies in secret.

Dieting is a tricky issue. Personally, I don’t see any other way to lose weight than to cut calories. Yet, it would seem that the psychological distinction between what kind of eater you are is an important one. So, the style of diet upon which you embark will also be a highly individual undertaking: in other words, high protein diets won’t work for everyone, but they can work for some.

Authors of the current paper suggest that our 24 hour access to chocolate whip cream mochas is so extremely stressful, that it is causing the development of binge behaviours. In essence, by virtue the plethora of cakes and goodies, we all run the risk of developing binge eating behaviour.

Personally, I’m a little skeptical about that view.

Yet I do hope that before you rush to buy plastic coated detox pills that you consider the fact that the more extreme a diet/ detox is, the higher the likelihood you will ‘fall off the wagon’ for a variety of reasons. One of them may relate to the cravings that you’ll experience when confronted with pictures of cheeseburgers and desert carts at restaurants.

Monday, I will explain the study in detail, and why dieting (not ‘detoxing’ or self starvation) may have some intriguing benefits. I will also try to explain why we may eat bags of cookies, and how palatable food overrides the sense of satiety, making it impossible for you to maintain any kind of caloric deficit.

Until then, Good luck with the bran flakes and arugula.

Learning about how living with obesity feels… On the way back from Edmonton, I am writing about visiting Alberta Diabetes Institute, and my sincere gratitude goes to Dr. Arya Sharma and Rebecca Tuepah for the tour of the lab.

Referring to the Alberta Diabetes Institute as a “lab” is just about the shabbiest of understatements. The availability of sophisticated technology here would be second to nowhere.

In spite of the hologram rooms and apartmet style calorimeter suites, the biggest shock of the day came from wearing a suit that mimicked obesity. Indeed, I had the opportunity to wear a set of carefully engineered foam pads that realistically portray the way fat is distributed for a person with morbid obesity (photos to come). After I explain what it feels like to put on pants – one leg at a time with my new experience of being overweight – I hope your opinion about obesity might change, too.

Time was of the essence- the ADI is massive, and we had a list of things to see at ADI – those hologram rooms were waiting, and the calorimeter apartments needed to be visited – so Dr. Sharma offered me a quick session with The Suit. The first task would be to put my own clothes on.

The good news first. My shirt came on without a hitch. Thanks to the advances of professional sports and especially the demands placed on athletes due to how much they sweat, we have created a wonderfully silky material that seems to just glide on over everything without too much of a hitch. Plus it’s breathable!

Brilliant.

So, now onto the next step: my trousers. Jeans, the original functional fashion item, have not really undergone the same kinds of transformation as things like t-shirts (what I’m assuming people wore before the polypropylene material I had in the shirt). Jeans are a heavier, crunchier material.
Less glide. More friction. You don’t have to be obese to sympathize here: put on a pair of your favourite jeans after the Christmas Holidays. No cheating. They must come directly out of the dryer.

See?

With this analogy in mind, I started to recognize how daunting the task of putting on pants may prove to be. Bending down to pick them up, and manually tracing the circumference of my Levis with my hands in attempt to strategically hoist the material over my body was my first (unsuccessful) attempt at dressing myself. You know, jump into the pant legs and sort of skip my way through the legs.

Thus far:
Pants= 1, Maargi= Nil.

Balancing on my right foot to lift up my left and slip it through the pant leg – without getting it caught or tripping – was the first hurdle. Next, I had to squat to angle my right foot, and ease the pants up over both knees – deep breath here – and pull my pants over the rest of my legs only to realize that clasping the button would prove to be another problem. What a total nightmare it is to find bloody buttons after sorting out how to find them without being able to see.

The logistical and strategic efforts were extreme, and at this point it should be noted that “The Suit” is not entirely accurate – the fat reserves are all carefully distributed, but they are made out of foam. It weighs about 30 pounds, providing merely the Training Wheel Variety to how “Real Deal” Obesity feels.

Apparently they are working on making a heavier version, just to ensure that empathy for obesity increases by another magnitude of about a million. And if empathy isn’t how one feels at the end of this experience, than maybe a friendship with the likes of Hannibal Lector might prove to be a rewarding exchange.

In other words, never before have I been more strongly convinced that obesity is not, in fact, a personal choice.

Obesity is probably the most complex, misunderstood condition of the 21st century. Right now, obesity expenditures in the US hover around $167 billion dollars, and back of the envelope calculations indicate that it is responsible for over 100,000,000 jobs lost (you arrive at this number by calculating presenteeism numbers)1. I finally got a sense of why these costs are so high when I had to try and live for one hour in a simulated suit. No wonder obesity related complications lead to an increase in absenteeism – this had nothing to do with even getting to a bus stop, let alone the kinds of responses one might encounter on a daily basis. Fat prejudice is probably one of the more rampant and accepted forms of bigotry, after all.

…But I guess to call this health crisis “misunderstood” would represent the second shabby understatement for this article.

Here’s to hoping that we can make some progress in this domain.

Living with obesity – sources
(Finkelstein, DiBonaventura, Burgess, & Hale, 2010)
1. Finkelstein, E. A., DiBonaventura, M., Burgess, S. M., & Hale, B. C. (2010). The costs of obesity in the workplace. J Occup Environ Med, 52(10), 971-976.

Despite insisting on engaging in daily hedonism, the latest diet craze from France is anything but pleasant. Miraculously, the ultra low carbohydrate, relatively low fat, high protein Dukan Diet food does the trick: I have seen numerous friends and family members drop anywhere between 4 to 10 kgs, and I have also had some luck with this – admittedly joyless – process.

Searching through journals to validate some of the psychological and dietetic principles involved, I realized that High Protein diets might be doomed. While low impact journals tout the benefits of Low Carb/ High Protein, the folks at Lancet are still snubbing Doctors like Dukan.
It is worth noting that France, the bastion of pleasure filled food fests, has produced a diet so restrictive that even North American Yo-Yo dieters question their ‘willpower’ to follow through with this plan.
I do believe that Dukan’’s regimen produces weight loss – most accutely in those individuals who have experienced confusion about the differences between ˊgoodˊ and ˊbadˊ carbohydrates.

More interestingly, though, is the drastic slash of foods associated with pleasure that is proposed in this diet. The Mediterranean Diet symbolizes the idea that ˊeverythingˊ enjoyed in moderation leads to optimum health. On the Dukan plan, it looks like even Olive Oil – the panacea for almost any ailment in Europe – is coming under attack.
Above all, this new diet craze indicates to me that Obesity, clearly, is no longer a ˊNorth Americanˊ problem. The French used to enjoy a degree of sanctimonious ˊI told you soˊs,ˊ about the benefits of wine, cheese, and chocolate fondue. No longer is this the case. It turns out that eating ˊeverythingˊ in ˊmoderationˊ may be in fact a surefire way to put on weight.

Part of our discomfort with the debate about obesity – and to an extent, the efficacy of low carb diets – is that we have lost sight of the fact that a ‘diet’ does not mean chocolate energy bars, high fiber brownies, or even low carb ice cream. A diet is needed to reform your eating patterns, particularly when your body is showing you that you are eating too much. Critically, the provision of Dukan paraphernalia does not yet exist. You cannot find Dukan ‘energy bars’, ‘mocholate’, or protein inspired cereals. For this reason alone, I am a fan of the plan.

Problematically, ‘healthy eating’ messages get watered down by the incorporation of healthy-ish foods. In attempt to ‘eat healthfully’, we may actually be trying to lose weight. The two may in fact be mutually exclusive. Foods that are indeed very high in nutrients, may immediately lead to an increase in our waist circumference – to say nothing of the consequences of eating food that is very high in pleasure, and low in nutrients. Sugar, fat, and salt all come to mind here.

Dukan goes to great pains to explain that while there are lots of foods that are nutritious, many of them have the pernicious consequence of weight gain. To sum it up briefly, for once, mais oui!, we have someone who has embraced the idea that we cannot eat ourselves slim. Tomorrow, I will in fact be posting how thermogenisis works, why high protein diets are effective (and not just because they are boring), and consider the controversy of their acceptance by the greater medical community (or, what I perceive to be a controversy).

Thank you for your time and consideration,

mx