Your Mother Should Know
America is home to the corporate consumption complex, but this problem exists all over the world. We stopped being individuals decades ago after the advent of GDP; we’re all consumers now. Technology, sleep deprivation, substance abuse, processed food—these are the killers of contentment and the drivers of desire, dependence, and depression. Connect, contribute, cope, cook: each of these has the capacity to pull you out of addiction by limiting the need for reward by optimizing the effects of dopamine and reducing cortisol—and lift you out of depression by increasing contentment and the effects of serotonin. None of these strategies are new, although the science behind them is. These are all things your mother told you when you were a kid, when you were still growing, but since then you may not have had time to adopt or enact any of them, because you have been too busy texting while quaffing a Coke—because the siren call of pleasure is just too great, and too immediate.
Happiness, our first garden, is our natural birthright, but we’ve been cheated out of it. In its place has been substituted a garden of earthly delights, and we’re all the worse for it. Some pay the ultimate price and slip into the abyss of eternal damnation. But that first garden is right in front of you, just behind the curtain of your own brain. You can reenter anytime you choose. I’ve chosen. I suggest you choose now. It’s time to reclaim your original garden as your own.
Epilogue
In 2014, I visited a major American medical school to give Psychiatry Grand Rounds on sugar and addiction. The administrator of the hospital’s substance abuse recovery program was a woman in her late forties, a former drug addict who had pulled herself out of her misery from opiate use. On being asked what addiction and getting clean meant to her, she replied, “When I was shooting up, I was happy. What my new life has brought me is pleasure.” When I heard this, I was quite taken aback. Of course, it’s exactly the opposite. People shoot up to recapture the pleasure of their very first hit. But they never can. So they inject more and more to derive less and less pleasure. It is not a coincidence that this woman misconstrued pleasure for happiness; this is exactly why she was an addict, albeit now in recovery.
I have known about the dopamine-serotonin-cortisol connection for at least three decades, dating back to my postdoctoral fellowship in a neurobiology lab at the Rockefeller University in New York. But it wasn’t until meeting and talking to this semi-unfortunate woman that I recognized how this seemingly trivial confusion might figure prominently in terms of why people become addicted in the first place. If she was so sure that she was happy while shooting up, I figured others might feel the same way. I’ve since talked to many of my colleagues in psychiatry and substance abuse treatment, and they corroborate that this view is commonly held among their patients.
Shortly thereafter, I was in Minnesota on a family vacation. My sister-in-law used to run the consumer response department at Pillsbury in Minneapolis before they were bought out by General Mills in 2001. She had to deal with all the phone calls from irate customers when the Poppin’ Fresh dough didn’t rise or when there was freezer burn on the ready-to-bake biscuits or crescent rolls. Although she has been gone from that job for over a decade, she is still convivial with the crew she worked with, and they see each other once a year or so for a gourmet club. One of her friends who had undergone bariatric surgery several years prior commented to my sister-in-law, “You look wonderful! So nice and slim. How do you do it?” She said, “I don’t need to eat much. I don’t eat when I’m not hungry.” To which her friend responded, “Don’t eat? Who eats for hunger? We’re not hungry either. Eating is about happiness.”
That was the aha moment. How many other people get it wrong? Of course, I take care of obese children on a daily basis, and I get to see and hear what their parents feed them and what they eat when they’re on their own. I knew this issue of eating for happiness wasn’t just anecdotal. Many patients tell me “food is my friend”—after all, it’s always there when they need it, it comforts them, and it never leaves their side. Well, you could argue, that’s exactly what’s wrong with people with obesity: they eat when they’re not hungry! And for a certain segment of obese people, there’s a lot of truth in that statement. But that leaves two questions that demand answers. First, why do they eat for happiness and how did they get that way? What made them need a surrogate friend, one that doesn’t talk back? And second, there are a whole lot of thin people who also eat when they’re not hungry, and they manifest the same diseases as do the obese, such as type 2 diabetes, heart disease, fatty liver disease, hypertension, cancer, and dementia; all of the diseases of metabolic syndrome. How many thin people are destined to succumb to one or more of these diseases, just because they didn’t know?
Either of these two clinical vignettes might have been passed off by the uninitiated as purely anecdotal. But the science and my clinical experience said otherwise. And as I researched the data for this book, the dark underbelly of Western culture and how it manipulates our beliefs and behaviors became ever more painfully exposed. We take it for granted that our society values money and its pleasures over all else, and then conflates those emotions with happiness. If parents don’t teach it directly to their children, then the TV or the internet will. This book just had to be written.
How many people are addicted to either a behavior or a substance, and they think it’s just a part of their general personality? They might say, “Oh, I have a horrible sweet tooth,” or “I’m a chocoholic from way back,” or that they frequently engage in retail therapy and post about it on Facebook for validation. No one comes out of the womb that way. You have to activate the dopamine pathway first. It’s reward, but it’s also learning—“This feels way good.” Once exposed, each of these behaviors becomes reinforced through activation of the reward pathway. And then the receptors start to dwindle. In no time, each individual becomes just another member of the mainstream consumer culture, another cog in the wheel of our economy, which boasts hedonic substances as commodity numbers two (coffee), four (sugar), and eight (corn, which is turned into high-fructose corn syrup).
I hope this book conveys that there’s nothing inherently wrong with pleasure—but not to the exclusion of happiness. Pleasure and happiness are not mutually exclusive, although in this book I’ve separated them as much as possible so as not to confuse the reader. After all, Wall Street, Las Vegas, Madison Avenue, Silicon Valley, and Washington, D.C., have confused enough people. My goal for this book was to scientifically parse the difference between these two ostensibly positive emotions, examine them separately, and watch what happens when you recombine them. You can, and should, have both pleasure and happiness in your lives. One will make the other that much sweeter. There are moments in life when you can experience both simultaneously (your team winning the Super Bowl or an Olympic gold medal, attending a wedding, going on a great vacation, having a child, or finishing a job well done at work), which elevates the baseline feeling of contentment to joy or elation, and we might find those experiences nothing short of rapturous. Sometimes the amplitude of simultaneous emotion is so great that we cry. These events are likely to leave the largest imprint on our memories, and will likely stay with us for the rest of our lives. In the future, when we pull them out of our subconscious and examine them, the sense of reward will have long dissipated, but the contentment within the memory will still be there. And don’t forget, things that generate pleasure often can be expensive, but things that generate happiness are dirt cheap.
The prediction of our demise due to our quest for pleasure is attributed to Aldous Huxley, who pronounced, “What we love will ruin us.” In Brave New World (1932), he described a human race that by the year 2540 had been destroyed by ignorance, technology, constant entertainment, and material possessions. But his forecasting was off by four centuries, as we’re already there. Conversely, Tolstoy buffs will recall that in War and Peace (1865), after protagonist Pierre Bezukhov is incarcerated by the Frenc
h, he has ample time to ponder the meaning of existence. Awed by the serenity of a fellow prisoner, Pierre learns “not with his intellect but with his whole being . . . that man is created for happiness, that happiness is within him, in the satisfaction of simple human needs, and that all unhappiness arises not from privation but from superfluity.” In his captivity, Pierre postulates the virtuous simple life as the shortest route to contentment: “The satisfaction of one’s needs—good food, cleanliness, and freedom—now that he was deprived of all this, seemed to Pierre to constitute perfect happiness.”
The keys to benefit from pleasure and happiness are to understand the differences between the two, because even though pleasure and happiness are not mutually exclusive, they can still be opposites. There is plenty of room for pleasure in life, and lots of things can bring you pleasure. But no thing can make you happy. Experiences can make you happy. People can make you happy. You can make you happy. There are many ways to get there, and I’ve outlined them in this book. Each of them necessitates that you peel back the curtain of your own brain. There are many obstacles—your boss, your friends, your family, and of course even you—and they will derail you, but only if you let them, and only if you don’t know the difference. To paraphrase Benjamin Franklin, a great pleasure seeker himself: Those who abdicate happiness for pleasure will end up with neither. The science says so.
ACKNOWLEDGMENTS
As stated in the introduction, I am not a psychiatrist or an addiction physician. But I am a quick study. And I’ve had some very good teachers along the way.
I work with five different teams of scientific investigators and clinicians, each of which has helped me to understand the concepts that pervade this book. First, my colleagues from the UCSF Osher Center for Complementary Medicine have been instrumental in helping to establish the concept of reward-eating drive and the addictive effects of sugar. Elissa Epel has been my friend since the day I arrived at UCSF. The rest of the Osher group, including Ashley Mason, Nicole Bush, Jeff Milush, Eli Puterman, Doug Nixon, Patty Moran, Kim Phox-Coleman, Jennifer Daubenmier, Barbara Laraia, Mary Dallman, Peter Bacchetti, Michael Acree, and Fredrick Hecht, have worked tirelessly to benefit obese patients. Second is my metabolic team from both UCSF and Touro University. Together we have uncovered the toxicity of sugar and its role in fomenting chronic metabolic diseases by removing it from childrens’ diets. I am indebted to Jean-Marc Schwarz, Kathy Mulligan, Alejandro Gugliucci, Susan Noworolski, Viva Tai, Mike Wen, and Ayca Erkin-Cakmak. Third are my colleagues at the UCSF Institute for Health Policy Studies, who recognize that non-communicable diseases are the greatest global health threat in the history of mankind—and they’re all due to hedonic substances. First it was alcohol, then it was tobacco, and now it’s sugar. Laura Schmidt, Stan Glantz, Claire Brindis, and Cristin Kearns understand the intersection of science and policy, and have helped translate the work into meaningful public health messaging. Fourth, my colleagues at the UCSF Center for Global Health, who can take policy and model it into money (saved), because this is the only thing that governments care about. Jim Kahn, Rick Vreman, Alex Goodell, and my dietitian and current grad student Luis Rodriguez have all been instrumental in expanding the message beyond the American border. And finally my clinical team at the UCSF Weight Assessment for Teen and Child Health (WATCH) clinic, where instead of treating the obesity (which doesn’t work) we treat the metabolic dysfunction (the insulin problem) and watch the pounds melt away. Patrika Tsai, Kathryn Smith, Meredith Russell, Luis (again), Nancy Matthiesen, and Megan Murphy are the reason it’s still fun to go to clinic each day. I also must thank Marc and Lynne Benioff for believing in this work and for their support of our research at UCSF.
I also work with many psychiatrists, some of whom double as rat researchers studying dopamine and serotonin, and who have helped advance the concepts in this book. Among them are Larry Tecott, Steve Bonasera, Nicole Avena, Ashley Gearhardt, Mark Gold, Rajita Sinha, Ania Jastreboff, Mark Potenza, Eric Stice, Mark George, and Jeff Kahn. I’ve also had some very informative discussions with Steve Ross, Brian Earp, Adam Gazzaley, and John Coates during a fun weekend in Mountain View, and they helped to fill in some of the pieces. One person who deserves special mention is Bill Wilson (not that one), a tremendously astute clinician who can see patterns in patients, and who helped me understand the role that carbohydrates play in brain dysfunction, confusion, and unhappiness.
The arc of this book also dovetails into history and law. I particularly want to thank my law mentors turned colleagues David Faigman and Marsha Cohen of UC Hastings College of the Law. Also a nod to Michael Roberts of the UCLA Resnick Center for Food Policy and Law.
Here in the U.S., we started a non-profit called the Institute for Responsible Nutrition, now the science arm of a new entity called EatREAL, to provide the science to alter the global food supply, in order to eradicate childhood obesity and type 2 diabetes. My colleagues Jordan Shlain, Wolfram Alderson, Lawrence Williams, and our supportive board have been instrumental to furthering the cause. We also work with two sister organizations here in San Francisco: Wellness City Challenge with Cindy Gershen and Pam Singh, and Andrea Bloom of ConnectWell. Julie Kaufmann of the American Heart Association has also been an enthusiastic supporter.
The battle for our food supply is an international one, and I’ve got some amazing colleagues stretched over several continents. In the UK, Aseem Malhotra and David Haslam of the National Obesity Forum spelled out the danger, Jack Winkler helped craft the argument, and Graham MacGregor and colleagues at Action on Sugar had the government’s ear as the UK Sugar Tax was enacted. In Mexico, I am indebted to Juan Rivera Dommarco of the Instituto Nacional de Salud Publica and Juan Lozano Tovar of the Ministry of Social Security of Mexico for their work behind the scenes on the Mexico Soda Tax and benefiting the Mexican people. In the Netherlands, Albert van de Velde, Martijn van Beek, Peter Klosse, Hanno Pils, Peter Voshol, and Barbara Kerstens of the non-profit Voeding Leeft (Food Lives) are fighting the good fight. And in Australia and New Zealand, my colleagues Rory Robertson, Gary Fettke, Simon Thornley, Kieron Rooney, Rod Tayler, David Gillespie, Sarah Wilson, and Gerhard Sundborn have made a remarkable stand against entrenched forces in both academe and parliament that seek to undermine the population Down Under. I’m also indebted to some unlikely international allies: members of the finance profession. Stefano Natella, formerly of Credit Suisse, is a true Renaissance man. No one gets the problem better than he does, and he is using his position to sway business to forge a better society. Caroline Levy and Philip Whalley of CLSA also deserve a great deal of credit for helping to move the message about the role of sugar in the food supply.
Other academic faculty have contributed greatly to my knowledge. My UCSF ex-boss Walter Miller has always been a role model of the uncompromising scientist. Synthia Mellon and Owen Wolkowitz taught me about steroids and brain function. Nobel Laureate Stan Prusiner and my best friend in science Howard Federoff have helped to delineate the role of sugar as a potential driver of dementia through fatty acids in the brain. Dieter Meyerhoff explained the neuroimaging of alcoholism. Justin White tutored me in behavioral economics. Michele Mietus-Snyder counseled me on lipids and mitochondria; Laurel Mellin on stress, negative emotion, and its effects on obesity; Nancy Adler on vulnerable populations and social determinants of disease; Jyu-Lin Chen on East Asian populations; and Alka Kanaya on South Asians. I also want to thank Alexandra Richardson of Oxford University, who taught me the magic of omega-3s; Dacher Keltner, who teaches a course in positive psychology at UC Berkeley; and John Graham, a professor of marketing at UC Irvine.
Others have helped to espouse the public health message. Kelly Brownell is the dean of the Sanford School of Public Policy at Duke University. Matt Richtel is a Pulitzer Prize–winning author who has written about the texting and cell phone issue. Jim Steyer of Common Sense Media was the first to Talk Back to Facebook. Many people in the media have also been integral to dissemination
of the message. Corby Kummer of the Atlantic, Patty James and Bill Grant of the Commonwealth Club, Laurie David and Stephanie Soechtig of Fed Up (2014), Michele Hozer and Janice Dawe of Sugar Coated (2015), and author Gary Taubes, author of The Case Against Sugar (2017), are all allies.
One weekend in August 2015, my friends Fred Aslan and Jack Glaser (as well as Jack’s wife, Elissa Epel, and her parents) and I unwittingly spent a silent meditation weekend in the mountains with Buddhism instructor James Baraz. Fred, Jack, and I all deserve gold stars for making it through that weekend, and James as well for putting up with the three of us. You try it sometime. We were like kids in detention. But that experience was seminal to integrate the religion together with the practice of mindfulness together with the neuroscience.
This book was particularly difficult to write, due both to its tenor and its content. My agent Janis Donnaud and publisher Caroline Sutton had to deal with several work stoppages due to grants, personal illness, and the death of my mother. They could have pulled the plug, but they didn’t, because they believed. I’m indebted to them for seeing it through to the end. I also need to thank my personal friends Matt Chamberlain, who kept my internet up and running, and my graphics design gurus Glenn Randle and Jeannie Choi. Mark Gold, Walt Miller, Elissa Epel, David Faigman, Ashley Mason, Bill Wilson, and Kathy Laderman read early versions of the manuscript and provided comments.
My penultimate thanks go to my writing team: my editor Amy Dietz and my researcher Deanna Wallace. Amy’s father was a neurologist who named her for the amygdala, a bit of foreshadowing of her life to come. This is our second foray together, and we haven’t killed each other yet. Amy brought three special qualities to this book. First, she obtained her master’s in public health at the University of Washington and is able to look at health problems through the wide lens and break down difficult concepts for the lay reader. As someone in recovery, she was able to bring her own experiences and those of her friends to this book, which both humanized the often distasteful topic of addiction and also helped me to understand what I was actually writing about. And lastly she is a hoot. This book could have been so dry it would crumble, but Amy’s wit and facility with popular culture has made it juicy and relevant, and hopefully gave you a chuckle. Deanna has broad expertise in reward behavior, dopamine, and cognitive neuroscience, obtaining her Ph.D. with Eric Nestler at the University of Texas Southwestern Medical Center, completing postdoctoral training with Mark D’Esposito at UC Berkeley, and currently working as a researcher at UC San Francisco. She is also married to Mike Donovan, a serotonin researcher at UCSF. Deanna was the “bulls—t detector” of this project. She vetted the scientific articles to make sure they said what I thought they did and made sure they passed muster, sometimes to my chagrin. She was a gifted backstop and is a truly remarkable human being. Yet Amy and Deanna are completely different: Amy is gregarious and Deanna demure. On different days, my ranting and raving would invariably put one of them up a wall. But I couldn’t have written this book without them, and I love them both.
The Hacking of the American Mind Page 27