Guess what? Every aspect of their metabolic health improved significantly after just ten days of eating the lower-sugar meals. Their subcutaneous (big butt) fat did not change (after all, they had not lost weight), but their visceral (big belly) fat dropped and, more importantly, their liver fat dropped a lot.15 Their blood lipids (markers of heart disease risk) all improved, and in just ten days.16 We improved their metabolic health and quality of life without changing their weight. And most importantly, they all felt better! They had more energy, they could concentrate better, and anecdotally the parents said that they were less disruptive in class.
So what about mental health? Is the acute buzz from each soft drink worth the eventual negative impact on mood? In preschoolers, sugared beverage consumption correlates with behavioral problems.17 In teenagers, sugared beverage consumption correlates with violence, severe depression, and suicidal thoughts.18 Studies in Australia and China show that sugared beverage consumption correlates with unhappiness independent of chronic disease development.19, 20 Furthermore, a study of pregnant Norwegian women found a direct relationship between sugared beverage consumption and loneliness.21 Of course, these studies are all correlational, not causational. These data do not clarify whether soda can make you lonely, depressed, and violent, or whether lonely, depressed, and violent people are more likely to drink soda or eat Ben & Jerry’s as their reward.
Stepping Down from the Food High
There are at least three reasons to eat: hunger, reward, and stress.22 Within the SHINE study (see Chapter 18), our UCSF reward-eating team examined how obese women’s reward system drives their food intake toward problem foods and whether stress heightens the reward response to specific foods.
We found that one-third of the obese subjects in our study reported times when they experienced a loss of control over their eating, and when they did, they gravitated to highly palatable (high-sugar, high-fat) foods. The question was: Could a mindfulness-based intervention reduce both their stress and their food cravings in order to improve their metabolic health and their mental health?
First, we needed to determine who these subjects were. Our UCSF reward-eating team developed and tested the Reward-Based Eating Drive (RED) scale.23 We also found that reductions in reward-driven eating predicted the success of a mindfulness-based weight loss program.24 Other studies have shown that obese people exhibit a loss of dopamine receptors (tolerance) in the reward pathway.25 These data implicate both the dopamine and the EOP systems (see Fig. 2-1) in this type of reward-based eating drive.26, 27, 28
The next thing we needed was a biomarker or lab test of reward-based eating, something that would inform both the subject and us that the reward system was in overdrive and at the root of their eating behaviors. We already knew that some people who were exposed to a drug called naltrexone (which specifically blocked their EOP receptors; in order to block the consummation of the rewarding behavior, see Chapter 3) would often become nauseated and reduce their eating, particularly of sweet, high-fat foods,29 but would not alter consumption of regular foods, such as protein, fruits and vegetables. Naltrexone (Revia) is a cheap, safe compound that can damp down the reward system of drug addicts but does relatively little in everyone else. A subset of our SHINE subjects took one naltrexone pill to acutely block the reward system. We noted that those who scored highest on the RED scale at baseline were the ones who developed nausea in response to the naltrexone, suggesting that these subjects had the highest baseline EOP function.30 In another study, we found that obese women highest on the RED scale had the largest reductions in food-craving intensity after taking the naltrexone pill.31 In these series of studies, we found that the people with the highest reward-driven behavior were the most responsive to our blocking of their reward system. Therefore, we were pretty sure that we had found a probe to study the biology of food addiction.
Lastly, we needed to find out whether we could affect this system with a behavioral intervention (e.g., mindfulness) that reduces food cravings and stress. We followed these subjects through their diet and exercise interventions either with or without the mindfulness intervention. Perhaps it shouldn’t be surprising that those who received the mindfulness eating and stress intervention, rather than the more general intervention that didn’t focus on reward-driven eating, experienced large reductions in their reward-driven eating, and that these reductions in reward-driven eating led to weight loss.32 What’s more, it was really about the reductions in reward-related eating—not the reductions in stress—that were key to weight loss. What was interesting was that these vulnerable people, with their broken reward systems, showed these improvements more so in the meditation condition, when they got the extra training to improve their mindfulness (see Chapter 18).
In this series of experiments, we showed that:
Not everyone with obesity is the same.
Some people experience a loss of control with certain foods.
Those that do tend to binge on high-sugar/high-fat foods (think chocolate cake).
This aberrant eating behavior is driven by dysfunction of the reward system.
The stress system piles on to disinhibit cognitive control of food intake.
Blockading the reward system unmasks both the reward and stress systems.
Mindfulness can restore functionality to the reward and stress systems, leading to improved mood, less disordered eating, and less risk for metabolic syndrome.
So here’s the question. Let’s say you’re one of these sugar-addicted people. Maybe you employ lots of restraint to stay away from the obvious triggers: soda, cakes, ice cream. But you still have to eat. And what if your food has sugar mixed or baked right into it and you don’t know it? Can you break an addiction if the addictive substance is so pervasive that it’s in everything but you don’t know it’s there?
Then on top of the added sugar, go ahead and reduce the other two molecules from Chapter 9 that increase contentment: tryptophan and omega-3 fatty acids. Tryptophan is very low in processed food because protein sources of tryptophan are relatively expensive. Omega-3 fatty acids are even more expensive, and tend to provide a fishy odor to food. Processed food is high sugar, low tryptophan, low omega-3s. Great for reward but risky for both addiction and depression.
Winning the Battle Against Big Sugar
This, my friends, is the explanation for America’s, and the world’s, love affair with processed food. By slowly adding sugar not just to desserts but to diet staples and condiments as well, the food industry has been able to hook us and keep us hooked (see Chapter 14). The fat and the salt, while not addictive themselves, serve to increase the salience of the added sugar (see Chapter 6).33 Then, of course, add the second legal addiction—caffeine—to soft drinks, energy drinks, coffee beverages, and the like to provide the second hook. The bitterness of the caffeine is more than offset by the sugar. Plus caffeine increases the salience, or rewarding properties, of sugar.34 Two addictions—and it’s all completely legal, because both sugar and caffeine are Generally Recognized as Safe (GRAS) by the FDA. That means the processed food industry is allowed to use any amount it wants in any food it chooses, and with no repercussions. This designation of GRAS is the least policed administrative law in all of Washington. The GRAS determination provides the underpinning for the success of the entire processed food industry. This is how and why the processed food industry changed our food supply forty years ago, and why we’ve gotten sick and unhappy ever since. And it’s why every country that has adopted our food supply has suffered the same fate. Even the U.S. Government Accountability Office says that GRAS is dangerous as a designation,35 and lawyers are starting to call for the revocation of sugar’s GRAS status,36 similar to how trans fats were removed from the GRAS list. A group of doctors, lawyers, and entrepreneurs in San Francisco have started a nonprofit organization called EatREAL (eatreal.org) to reverse diet-related disease by changing the global food supply. One of our long
-term goals is to get sugar removed from the FDA’s GRAS list.37 I am proud to serve as chief science officer.
The good news is that after decades of tallying record profits right up until 2012, the soft-drink and fast-food industries all of a sudden aren’t doing so well. McDonald’s, Coca-Cola, and Pepsi consistently outperformed the S&P 500 for the previous three decades. In 2014, Muhtar Kent, then CEO of Coke, with declining profits, announced the firing of eighteen thousand employees (although the savings was going to be plowed back into advertising, especially to children), and in 2015 Don Thompson, then CEO of McDonald’s, was fired for poor performance. British sugar company Tate & Lyle lowered expectations on 2015 profits due to declining sugar demand. Some companies have recognized the problem and are trying to get ahead and even take advantage of this global trend of sugar reduction in processed food. For instance, in the Netherlands, the grocery chain Albert Heijn has pledged to reduce the added sugar in hundreds of their store-brand grocery items, including yogurt, cookies, custard, and ketchup.38
Furthermore, in response to the global obesity and diabetes epidemics, several countries have examined the research themselves. They are working to oppose the entrenched food industry lobbyists, and some have enacted a sugar excise tax (soda and junk food) in order to get people to reduce consumption by reducing effective availability. Thus far, Mexico and the UK have enacted such a tax,39 while Australia, New Zealand, South Africa, India, and even Saudi Arabia are considering similar legislation. Closer to home, we’ve seen six American cities—San Francisco, Oakland, Berkeley, and Albany, California, as well as Chicago and Philadelphia—enact sugar taxes to generate money for programs and reduce consumption. No information on changes in health or happiness from any of these governmental maneuvers as of yet. But, not surprisingly, there is quite a bit of pushback from both the lobbyists and the people who feel this falls strictly within the realm of personal responsibility. But does it?
In other countries around the world, sugar consumption within soft drinks and processed foods is on the rise40 because of lax rules and, just like what happened to tobacco: once America started tightening the screws on cigarette availability and use, the tobacco companies moved offshore in an effort to addict new populations. And in these countries the sugared-beverage industries have a leg up, because people have to drink but they don’t trust their water supplies.41 And who provides the water-purification apparati for most third-world nations? You guessed it . . . Coca-Cola.
Sugar “Pop-Aganda”
The food industry has kept us off balance for years by deflecting criticism with its “commonsense” yet fallacious refrain, “A calorie is a calorie.” It’s the quantity of those calories, not the quality. This has been the core of its business strategy for at least fifty years. My public policy colleagues at UCSF have unearthed industry documents dating back to 1965 that show that the Sugar Research Foundation (the PR arm of the sugar industry) paid two scientists a handsome sum ($50,000 in today’s dollars) to publish two reviews in the New England Journal of Medicine that exonerated sugar and pinned the blame for heart disease on saturated fat.42 Furthermore, they also showed that in 1971 the corporate suspects infiltrated the NIH agenda to steer research on dental cavities away from sugar reduction and instead to promote a vaccine that never materialized.43 The food industry continues to put its thumb on the scales of objectivity, both figuratively and literally. Five out of six studies funded by the industry show no effect of sugared beverages on weight gain, while ten out of twelve studies by independent scientists show a clear effect on weight gain.44 More recently, Coca-Cola was exposed in paying off three scientists to form the Global Energy Balance Network to pin the blame for the obesity epidemic on lack of exercise.45 In fact, the soda industry has given away a total of more than $120 million to ninety-six separate public health organizations to promote anything but food industry regulation.46
The processed-food industry has another trick up its sleeve as well: redefining portion size. Consider processed peanut butter. If you spread a bagel with peanut butter, a standard serving is two tablespoons containing 188 calories, with 3 grams of sugar. Very few people use only two tablespoons for a PB&J. Yet Nutella, in a battle for stomach-share of peanut butter-gorging kids everywhere, and in an attempt to undercut its competition, successfully argued that it should be reclassified as a “jam” rather than as a peanut butter, and so its portion size should read lower, at only one tablespoon, with only 100 calories (half as much as their competitor). Nutella is hoping you’ll miss the 10.5 grams of added sugar.47
Worse yet, our processed food diet has been engineered by the food industry to be “fortified” with all sorts of vitamins, minerals, and a panoply of additives—whatever’s trending (lycopene, flavonoids, resveratrol)—supposedly to give us all the nutrients we need. This is the basis of the $121 billion nutraceutical industry. You need great hair! Great skin! Perky breasts! And the “natural” key is: bull semen, jojoba, lychee, raspberry ketone, açaí berry. You should cleanse, get an enema, juice! There’s always a new pop-up clickbait on your internet news feed with a miracle cure for being happy and never aging. The FDA doesn’t regulate nutraceuticals and companies don’t have to show efficacy: after all, they’re “food.” But you’ll never see “What I Did to Be Happy!” clickbait articles for the brain biochemical that can lead to happiness—the right kind of real food.
At the other end of the spectrum, the diet sweetener industry has argued that “a calorie is a calorie” means that their products, by providing sweetness without calories, is the better choice and certainly the best choice for those with obesity. Artificially sweetened beverages now account for one-quarter of the global market. Except for one little problem: they don’t work. A recent meta-analysis of all the studies substituting artificially sweetened beverages for the full-calorie version showed absolutely no change in weight and displayed a now-familiar bias: those funded by industry show weight loss, while those conducted by independent scientists show absolutely no change in weight.48
Processed Food: An Experiment That Failed
The science is in. Processed food is addictive, can make you extremely unhappy, and may ultimately kill you.49 Processed food is the exposure you can’t escape, because it’s everywhere. Except you can—but you have to be mindful of it in order to do it. Washington will never get on board, as protection of American business trumps protection of the American public. So it’s up to each and every one of you. Based on the science presented throughout this book, I offer to you my single most important key to happiness: COOK REAL FOOD FOR YOURSELF, FOR YOUR FRIENDS, AND FOR YOUR FAMILY! It’s connection in that you will be sitting down with people you like (and maybe even love); it’s contribution because you are making something worthwhile; it’s focusing so it’s easier to cope; and, unless you spike it with something, it’s non-addictive. The amount of sugar in processed food far exceeds what you would include yourself. If you use real ingredients, it will be delicious. It’s one of the key ingredients to contentment. And real food means low sugar and high fiber; the fiber feeds your microbiome so your bacteria will be happy as well. You may lose weight, and you will definitely reduce your risk for all of the chronic diseases of metabolic syndrome. And you will be sticking it to the companies who are trying to addict you and your family.
The problem is that one-third of Americans currently don’t know how to cook; they’ve fallen prey to the food industry’s endgame. Microwaving is not cooking: it’s boiling water. If you don’t know how to cook, you’re hostage to the food industry for the rest of your life and unwittingly will pass this on to your children. You can farm out the shopping; there are companies that will buy the real food and deliver it to your door for you to assemble. Similarly, you can farm out the cooking: there are other companies that will dirty their kitchen instead of yours. Getting ahead in life isn’t just taking extracurricular classes and joining the debate team—it’s actually cooking and (shocker) spending time
with each other. Not just at the table looking down at your favorite gadget, but actually engaging in meaningful conversation. There is nothing that will improve your health, your well-being, your achievement, your sense of accomplishment, your sense of community, and the health and happiness of your family as much as cooking for yourself and enjoying a meal with others. It costs time, to be sure. But it saves money—lots of money—both in food costs and in medical bills.
Processed food is no different from any other substance of abuse. Technology brings along its attendant multitasking and sedentary behavior and sleep deprivation. You may have fallen prey to any or all of these ploys over the last forty years. Yet you didn’t succumb to any of these rewards because you needed them; rather, you wanted them. Maybe because everyone else wanted them, too, as conformity is its own form of stress. Nonetheless, you bought your way in. Just like they planned.
The Hacking of the American Mind Page 26