Dr. Nicole Avena - The Psychology of Eating

Dr. Nicole Avena
Assistant Professor of Neuroscience, Icahn School of Medicine at Mount Sinai

Dr. Nicole Avena is a research neuroscientist and expert in the fields of nutrition, diet, and addiction. She is a pioneer in the field of food addiction, and it was her seminal research work that jump-started this exciting new field of exploration in medicine and nutrition. She is also an expert in diet during pregnancy, and childhood nutrition.

Dr. Avena received a Ph.D. in Psychology and Neuroscience from Princeton University in 2006. She then completed her postdoctoral fellowship in 2010 at the prestigious Rockefeller University in New York City, an all-research institution that lays claim to having had 24 Nobel Prize winners on its staff over the years.

Dr. Avena presently is Assistant Professor of Neuroscience at Icahn School of Medicine at Mount Sinai in New York City and a Visiting Professor in Health Psychology at Princeton University. She has published over 90 scholarly journal articles on topics related to diet, nutrition, and overeating, and she frequently presents her research findings at scientific conferences and University symposia. Her research achievements have been honored by awards from several groups including the New York Academy of Sciences, the American Psychological Association, and the National Institute on Drug Abuse. She has received research funding from prestigious sources, including the National Institutes of Health and the National Eating Disorders Association.

Dr. Avena’s book, Why Diets Fail (2014, Ten Speed Press) reviews the research on food addiction and provides a way in which people can remove added sugars and carbohydrates from their diet. She has another best-selling book, What to Eat When You’re Pregnant (2015, Ten Speed Press) that provides moms-to-be with nutritional advice on what to eat to ensure they and their baby are healthy. Her next book, What to Feed Your Baby and Toddler (released in May 2018), covers nutrition for babies who are just beginning to eat and offers science-based advice and practical tips on how to get your baby to eat healthy foods, like vegetables.

TRANSCRIPT

Dr. Pompa:
Well, welcome Nicole. We are so excited because you’re going to be speaking at our big event. This is a great event, because first time the public, we’re actually having the public. We have doctors from all over the world there, literally. The experts from around the world. Scientists from the Netherlands, from across America, on ketosis, fasting, diet. You name it. I’m telling you, your talk may be the most useful of all. Even for the doctors there. All of that’s fine, fasting, ketosis, and all these things that everyone is going to be learning about. Cancer. If you’re addicted, and you can’t break your habits, to any food-

Nicole Avena:
Right.

Dr. Pompa:
Then we’re all dead in the water. We might as well all just shut our mouths and go home. Your talk could be the talk of the seminar. Go ahead.

Nicole Avena:
That would be great. And I think, it really does touch on a big point that the addiction component of food, sugar addiction particularly, which is what I’ll be talking a lot about, it’s such a big part of all of this. Of wellness, of eating healthy, and it’s really the barrier that many people face before they can embark on whatever health journey they want to go on. I’m going to be talking a lot about the psychology of it, and why sugar is addictive. What you can do to avoid it from happening in the first place, and what you can do to mitigate it once it has happened. Really just get into the science behind it, because there’s so much research that’s gone on to this topic now, that it’s just such an interesting part of it.

Dr. Pompa:
Yeah. Again, we have Dominic D’Agostino talking about ketosis, etc., but I have watched more people fail because of the psychology around eating. Sugar addiction, etc., ketosis, fasting, all of the things we’re discussing. Matter of fact, I’d say cancer’s a big topic of the seminar, and again, people are extremely addicted to sugar because the cancer cells desire it. Again, you’re not going to win this battle, oftentimes in the physiology, it is psychology. Talk a little bit about that.

Nicole Avena:
Yeah. I think that’s why I’m so happy to be speaking at this event, along with these other wonderful speakers, and these topics that are so related. I think that the psychology of eating is something that we don’t always think about. We just think, “Oh, okay, we need to change our habits. We need to eat healthier.” We get this plan, we get this information, and we say, “Okay, let’s go ahead and do it.” But, we can’t because it’s so difficult. There’s so much that goes into habit formation. Our brains are actually rewired, and it is difficult to change that wiring once we’ve been eating in a way for a very long time. That’s really where the psychology of this comes in, in understanding the intersects between psychology and neuroscience, which is my area.

Really, how can you change that wiring in your brain? How can you change those habits? How can you think differently about the foods that you’re eating? How can you break those craving cycles, and how can you really get on a track that you want to be on, where eating the types of food you want to eat and you’re able to put sugar and carbohydrates aside? It’s not always easy for everybody, but that’s why I hope people come and hear my talk, because I’m going to walk people through the research and how you can do it.

Dr. Pompa:
Yeah. How did you get into this?

Nicole Avena:
Oh, boy. I got into this a long time ago. I was actually a grad student at Princeton University, I was doing my PhD there. The professor that I had started doing research with, we just started talking about things that I could study for my PhD. I was really interested in the brain and food, and why people choose to eat certain foods over the others. We started thinking about, maybe people choose to eat certain foods because they’re addicted to them. Maybe they can’t control their choices in the ways that drug addicts can’t always control their choices. That led into this whole, what’s turned into a career for me of understanding how sugar affects the brain, and what we’ve uncovered is, is that it effects in a way that’s very much like an addictive substance. The same effects you’d see with drugs, like nicotine or alcohol, even morphine, we see happening when people use sugar and overeat sugar, the same types of changes in the brain, the same types of behaviors emerge.

Dr. Pompa:
It becomes a point where it’s almost not their fault. This is creating, the cycle creates a physiology that you’re not going to win.

Nicole Avena:
Right.

Dr. Pompa:
If 3% of people can get off drugs for good, that shows you what you’re up against.

Nicole Avena:
Yeah.

Dr. Pompa:
There’s ways, obviously, to increase those odds. You’re going to share some of that at the seminar, but open that door a little bit.

Nicole Avena:
Yeah. Again, it’s certainly so difficult for people who are combating addictions to drugs and alcohol, but you also have to keep in mind that our society is created as such that we have advertisement bans on alcohol and on nicotine, and drugs, they’re not readily available, for most people. Whereas sugar, and foods, are everywhere. No matter where you go, you’re seeing advertisements for them. This is really an added layer of the battle. Is to try to figure out how you can navigate through these addictive substances of sugars and carbohydrates, in a world that is loaded with them. For many people who are suffering from drug and alcohol addiction, they can choose to avoid people who are using drugs, or avoid places where there’s alcohol, but for people who are suffering with an addiction to sugar, that’s not a possibility. Sugar’s everywhere.

That’s some of the things I’m going to touch on is, how do you navigate in a world that’s so sugar-centric and what can you actually do? How can you recognize where the sugars are? Even just from a simple social psychology standpoint of, how do you say no? How do you tell somebody, “Hey, I don’t want some of your birthday cake?” Or, “Hey, I don’t really want to have that slice of cake.” Because it happens to be an office party and I feel obligated. There’s so much social psychology around eating that that really plays into the discussion, too. I plan to talk a lot about that.

Dr. Pompa:
Those are the battles right there. If you don’t have a plan for those situations, like you said, for an alcoholic, the plans pretty easy. Don’t go into bars and stay away from those situations. It’s impossible with sugar. You can’t walk into a grocery store without being confronted by your addiction.

Nicole Avena:
It is. It is. That’s some of the things I want to talk through at the seminar. Really, how to recognize where sugars are, how to avoid them. And then, when you do encounter them, how to cope. Because I think that’s really the number one thing that trips people up, is that we get into these awkward social situations, or these impulsive moments where we end up wanting to give in. That’s what leads us down this path of derailment. I want to talk through how you can avoid that, and if it does happen, what you can do to rectify the situation.

Dr. Pompa:
This topic really plays into, you speak at the seminar on Friday, and Saturday is more of a cancer focus. What the doctors coming have to realize is this, you have to get these cancer people away from sugar. Sugar feeds the cancer cells. They’re going to hear that by many scientists. The scientists talk about, “Okay, sugar feeds cancer cells. Sugar feeds cancer cells. This is what you gotta do.” But no one’s talking about the 800 pound gorilla in the room, it’s like, “That’s all fine and good. But, these people have a greater desire for sugar, even than the average person.” What do you do about it? You’re going to be giving them some plans on here’s what you need to do. Otherwise, your cancer-

Nicole Avena:
Yeah. Right. I think that’s really the critical step, is telling people … Everybody knows they need to give up sugar, but not too many people know how to do it. Especially if you’re in a situation where you’re facing a cancer diagnosis or some other type of diagnosis where you have that added stressor involved. We have to remember, one of the main reasons why people use sugar is because it’s a way to self-medicate and make us feel good. When you’re taking that away in stressful situation, that just adds a whole nother dimension of issues that need to be addressed from a psychological standpoint.

I’m going to talk about some of the other coping mechanisms that people can use, or some other coping mechanisms that can be recommended, to get people away from using food as a drug. That’s essentially what happens. People have become addicted to sugar because they’re using it like it’s a drug. They’re using it to feel good when they’re depressed. They’re using it to make them feel better about themselves. Or they’re just using it because it feels good and it’s everywhere. It’s become this habit that’s developed over many, many years. I’ll talk about different ways in which we can turn all those things around so that people aren’t so dependent on it.

Dr. Pompa:
You’re coming to the seminar because you’ve become an expert in this. One of the leaders, that I recognize. I said to you before we started the interview, gosh, I can tell you as a practitioner, it’s too big of an elephant for me. I don’t want to tackle it. I would sooner say, “You need to go to this gal’s website. She is ….” You have to dial in here. That’s why practitioners, y’all have to learn this stuff. Honestly. Obviously, you’re giving the practitioner or the doctor strategies how to deal with it. Ultimately, you have to be able to recognize that there is a way so you can help these people. Because otherwise, you’re going to fail for your patient in front of you.

Nicole Avena:
Right. I think that’s the big thing, everyone who is working to help people, is to educate each other, and to provide people with the resources. No one’s going to do it all on their own for their patients. That’s really, I think, our goal is to educate other practitioners about where they can go to get the help that they need for their patients. And where they can direct them to get the resources and the assistance that they need.

Dr. Pompa:
In this seminar, in particular, I did something very different. Number one, the first time the public is actually going to be there. But, instead of just giving people problems, meaning, “Okay, we’re going to be talking about … Here’s that.” I brought people in, like yourself, to bring in some really good resources for the practitioner and the public, alike, to be successful. Again, I think that people fail in this area, more than any. It’s not dealt with, people are just shoved aside like, “They’re not disciplined enough.” You talk about that. It’s really not like that. It’s a much deeper issue.

Nicole Avena:
Yeah. I think that’s one of the things that I hope, there are research that we’ve been doing in my lab, and other people who have been doing similar research, has started to make people to see, it’s a biological problem. There is a brain basis to this. Just like with other addictions. We have to take the self-blame off of the patient, and start to look at this through the lens of a true addiction. Try to then treat it as a true addiction, and offer resources to people through that purview because I think for too, too many years it has been the idea that, “It’s the patients fault. They don’t have willpower. They’re not strong enough to do this, or they don’t want to do it.” That’s not the case.

I think that now that we’re starting to really understand this, through addictions and understand how the addiction process is working with food, then more and more people are taking that seriously. I think it’s really helping patients. The people that I’ve worked with and who I’ve talked to over the years, it’s really changed the way that they approach their diet and nutrition. When they hear that, “It’s not my fault that I can’t stop eating these things.” It really allows them a different way to look at the whole picture. I think that that’s really helpful for many, many people.

Dr. Pompa:
Are there different levels of addiction like there are with so many? I’m addicted to sugar, this person’s like, “No, you have no idea how I’m addicted.” Are there those levels like that?

Nicole Avena:
I think there are. This is just me speaking, from a research standpoint, we’re not there in terms of classifying different levels of addiction. I think that though, just from my reflection and working with people over the years, I think that all of us, even you and I, are at risk for becoming addicted to sugar, because of our environment. Just like if we lived in an environment that was loaded with drugs and alcohol nonstop, we would probably be at greater risk for becoming addicted to those things. I think everybody is at risk, for sure.

When it comes to the actual addiction, I think that there are people who have varying degrees of it, and I’ve met people over the years who have an addiction to the point where they have to do a full blown abstinence, they can’t have any sugar at all in their diet. Not even a drop of artificial sweetener, that’s enough to set them off. Whereas other people are able to adopt more of a harm reduction approach, where they can have slightly less sugar over time, and that’s allowing them to get control over how much they eat. It really depends on the individual. This is something I’m going to get into more at the seminar, in terms of how do you decide who is who.

Dr. Pompa:
Right.

Nicole Avena:
How do you decide if you’re a full blown addict, or if it’s somebody who maybe just needs some help mitigating some of these binges every once in a while.

Dr. Pompa:
That was my question. Yeah, you said that. Okay, I’m glad you’re going to get into that. That’s what I was saying. How do we identify these people? As a practitioner, I want to be able to identify them. Is there any association with people who have other addictions? Gambling, drugs? Are they going to sugar next once they’re off the gambling? Now they’re a sugar addict? Is there that crossover?

Nicole Avena:
Yeah. Right. There’s been, and I’ll talk more through the research at the seminar, but the two big links that have come out in the research have been the link between bariatric surgery and addictions to sugar. Also, alcohol and addiction to sugar. They seem to be two way streets, meaning that the research suggests that people who have a history of alcoholism in their family, or alcoholism themselves, are a greater risk for then having addictions to sugar. A lot of it goes back to the fact that alcohol is a sugar, right? That gets metabolized into sugar in our bloodstreams. It acts as a very powerful sugar in our brains. It makes sense to me, from that standpoint.

Dr. Pompa:
Yeah. Gosh, I can’t wait to hear more. Again, this is … We’re opening up a lot of cans of worms with different diets and the fasting. You’re going to address the 800 pound gorilla in the room. 1000 pounds, actually. The thing I love is you have answers, and you have solutions. Everyone needs to hear it. I appreciate you, Dr. Nicole, taking time out of your busy research schedule, and sharing your research and data with us. But you know what? You’re sharing it with some of the top doctors in the work that need to hear your research. That’s why I was like, “My doctors and the doctors, they need to hear what you’re doing. They need to hear this.” Thank you so much.

Nicole Avena:
I’m really looking forward to the event, and speaking to all the doctors, the practitioners, and the public that will be attending. I think it’s really going to be great and very educational for everybody.

Dr. Pompa:
Yeah. And like always folks, click here to sign up for the seminar. It’s going to be a game changer. Thanks, Doc. Appreciate you.