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INTRODUCTION In the summer of 2001, most of my friends, like me, had just graduated from college. They had chosen to move to big cities, get fancy jobs, and spend their nights hanging out with friends and going to concerts—typical stuff for twenty-something-year-olds. I, on the other hand, had chosen a different way to spend my evenings. I spent them feeding rats. Let me back up for a minute and give you some context. I had started graduate school at Princeton University that summer. I arrived in Princeton with a huge case of imposter syndrome. Imposter syndrome is the psychological term used to describe the feelings that people can get when they think they don’t deserve to be someplace, and that at any moment someone is going to discover they are a fraud or an “imposter” and expose them. (A topic for another book, I suppose.) No one in my family had ever even been to college, and here I was getting a PhD in neuroscience from an Ivy League school. I couldn’t help but feel that clearly, someone had made a mistake in letting me in. Despite the negative voices in my head, I resolved to push forward and do my best. I was assigned to work with a professor named Dr. Bartley Hoebel. His friends and students all called him Bart. He was a very tall (6′7″-ish), lean man, who had a quiet, gentle nature. He was a true Ivy Leaguer, having trained at the University of Pennsylvania and Harvard, and was now a well-respected professor at Princeton. He was accomplished, with hundreds of published scientific papers on what happens in the brain in response to people engaging in motivated behaviors, like eating, drinking, using drugs, or mating. He was regularly invited to give presentations all over the world to discuss his latest research findings. I thought that his research was fascinating and felt very fortunate to be his student. One day that summer, Bart asked me to come to his office so that we could have a meeting to talk about what I might want to work on as a research project that I could eventually turn into a PhD dissertation. This had to be a big idea—something that I would work on for the next five years of my life. Little did I know I would still be working on it over twenty years later. We started to talk about how there was a lot of interest in the scientific community regarding obesity at the time, as there still is now, and media reports often mentioned rising obesity rates. Keep in mind that the year 2001 was a while ago, and back then most people (including doctors) viewed obesity as being caused by a lack of willpower on the part of the individual, and essentially put all the blame on the person who was overweight or obese for being that way. We began thinking about how it was strange that, despite all the public health warnings concerning the dangers of being obese, and the multimillion-dollar diet industry that offered an array of choices and plans to follow to lose weight, people still couldn’t do it. The South Beach Diet®, the Zone Diet®, WeightWatchers®, the Master Cleanse®—these are just a few of the more popular options that many people tried and failed. They were being handed a plan, but it was impossible to stick to. Why? Could it all be about lack of willpower? And if, for argument’s sake, it was, what was causing people not to have the willpower to make healthier choices about what they ate? For some individuals who had obesity-related comorbid conditions, like diabetes or heart disease, this was a matter of life and death. It seemed like more than willpower was at play here. What if being overweight or obese had less to do with the person and their supposed lack of willpower, and more to do with what they were eating? Thanks to advancements in technology and agriculture, our food supply has continued to evolve. This is a good thing, as it has allowed us to avoid starvation and feed the increasing number of humans that inhabit the earth. However, when we look at the changes that have occurred over the past fifty years, it seems that many of these changes are for the worse. More and more people are relying on fast food, processed grocery store foods, and vending machines as a staple in their diet. And there is a common thread among these foods: they all contain added sugar.Pour on the Sugar Sugar. It has been around for centuries, and for most of that time we have lived in harmony with it, but that suddenly is changing. I will get into this more in the next chapter, but back in the early 2000s, we were coming off the “low fat” diet trend that had begun in the 1970s. Fat had been demonized by the American Medical Association (AMA) and other important medical groups because of its supposed negative impact on heart health, and these groups also argued that it caused obesity. To break it down to sound bites for the media: If you eat fat, you will get fat. Fat = bad, carbs = good. What started this idea? Back in the 1960s a physiologist named Ancel Keys published a theory that dietary fat raises cholesterol levels and gives you heart disease. This began a decades-long era in which all dietary fats were thought to be bad for your health. In the late 1970s, “Dietary Goals for the United States” was published, advising Americans to significantly curb their fat intake, and in 1984, the National Institutes of Health (NIH) officially recommended that all Americans over the age of two eat less fat. Turns out, they were all very wrong. But at the time, because the public had been sternly warned to avoid fats in fear that they would die from a heart attack or end up obese, most Americans were ditching the fats and, instead, eating more and more carbohydrates. This meant that in the 1970s we saw an influx of sugar in our food supply that slowly went up over time. You could see this for yourself when you went to the grocery store. Aisles were lined with “low fat” cookies and snacks, and they all contained added sugars. If you lived through this time period, you may fondly recall SnackWell’s®, which were a popular brand of fat-free cookies and other treats. People were (falsely) led to believe that you could indulge guiltlessly on them, because they were labeled as “fat-free.” Back then, it was fat that was bad for you, so companies were doing you a favor by taking it out of the products. The problem was that if you take the fat out, the food usually tastes terrible. So the food companies added sugar to make it taste good again. Sugar is a carbohydrate, so it was safe, and heck, better for you than the dreaded fat! All the while in the background, it was becoming apparent that sugar might not be all that good for us. Sweets were usually—and still are—the main topic of discussion when people wanted to lose weight. Many people for years had been talking about how they craved sugar, had a sweet tooth, and if they were trying to lose weight, giving up the white stuff was the hardest part. Sugar seemed to be a barrier for many people, and it stood in the way of losing weight. Giving up desserts and sweets was usually the tactic to try to lose weight, and usually the downfall for most dieters because it was hard to stick to. In the latter part of the 1990s another shift occurred. The media had begun to take note of America’s inability to give up the white stuff. You could pick up any magazine at the grocery checkout at that time and read a headline about “being hooked on carbs” or “ways to beat your sweet cravings.” Mass media hinted that people were hooked, in some way, on sugars and carbohydrates. Were these just sensationalized headlines to grab readers, or was there actually something to this idea? I started to look more carefully at some of the processed food products that were on the market—many contained so much added sugar, and in amounts that we would never ever see in nature. As a neuroscience student, I knew that the parts of the brain that evolved to regulate our appetite were used to concentrations of sugar that were more like what you would find in nature—for example, in an apple. But now, our brains were being blasted multiple times each day with the effects of ten times that amount of sugar from cookies, cakes, and protein bars. Not to mention all the sugar-laden foods that people were eating because they thought they were healthy, like some yogurts, salad dressings, and even fruit smoothies. It reminded me of what happens with drugs like heroin and cocaine. Part of the reason drugs like these are so addictive is because they over-activate the brain reward centers (more on this in chapter 3). They hijack the reward system and set our pleasure into overdrive. Drugs make you feel good (at first, at least), and our brain adapts accordingly to make us crave that feeling again and again, which makes us do almost anything to get it. I started to ponder: What if these processed foods that were so commonplace in our society, with loads of added sugar, were hijacking our brains in the same ways that drugs of abuse do? Could people be hooked on sugar in the way people get “hooked” on other things, like drugs and alcohol? Could people actually get addicted to sugar? After our initial discussion, Bart asked me to look into the scientific literature to see what I could come up with about sugar addiction as a basis for my dissertation. Excited to prove how great a student I was and to confirm to my inner monologue that Princeton was correct to admit me, I went off to the library to put together a literature review to discuss at our next meeting. But after hours and hours of scouring the medical and science databases for papers looking at sugar addiction, I came up with nothing. Not one single empirical study examined this. The term sugar addiction doesn’t even appear in search databases until 2002 (when we started publishing about it). Decades of diet and obesity research was out there, and none of it even flirted with using the term addiction. If anything, there were numerous studies fueled by the focus on heart health, suggesting that sugar and other carbohydrates were better for you than fat-rich foods. I felt deflated. One of the first things they teach you in graduate school is that when doing research, you need to have some literature (i.e., a strong basis) to back up your idea. You can’t just pull an idea out of the sky and do a dissertation on it! Now, the imposter syndrome was really kicking in. I would have to go back and tell Bart that I couldn’t find anything to support this idea, and I would have to slink back to the drawing board and come up with something else to study. But the next day, when I met with him and I told him about my failed search, he said something that completely changed my life. Instead of sending me off to come up with another topic to study, which is what I was expecting, he said, “I have a feeling this is something big. And if there are no studies on this, you better get down to the lab and start doing them.”It’s 10 p.m., Time to Feed the Rats Since we were starting from scratch with this idea, we had to come up with a model to test it. Bart had a rat lab, which was fortunate because looking back, it would have been impossible to do any of our initial studies on people, since finding participants to be in the control group that never tasted sugar would have been a challenge! So we developed a rat model where we allowed rats twelve hours each day to drink sugar, and then took it away (I’ll tell you more about the rats and the model in chapter 3). The idea of sugar addiction was completely new, so we didn’t have a big grant or much money at all in the budget to support these initial studies. That meant we had to be creative and industrious. Every night, one of my lab mates or I would go into the lab at 10 p.m. and take sugar away from the rats. My boyfriend (who was crazy enough to date someone with this type of work schedule and is now my husband) and friends all got used to me abruptly leaving the DBar, the shabby yet cozy on-campus bar and general hangout place for graduate students at Princeton, when I needed to go measure how much sugar the rats were drinking. Looking back, it was rather strange to leave my friends to go feed rats while they ordered another round of drinks, but at the time it felt completely normal. I won’t go into what happens next in the research, because you’ll read about all of that in chapter 3. But I will tell you that we set out conducting a series of experiments to try to answer the question: Is sugar addictive? Twenty-two years later, together with my lab colleagues, I have published over a hundred scholarly research papers on this topic. And we aren’t the only ones. Many, many more researchers have become interested in the effects that sugar has on our health, and there are now thousands of research papers on the topic of sugar and how too much of it can be dangerous to our health. The tide has dramatically changed, and sugar addiction is well established as a contributing factor to obesity, overeating, and poor health in general.What’s Next? That is the story of how I got here. Now, let me tell you why I stayed here. I have learned so much over my career about the damaging effects of sugar, and the damage goes even further than I initially thought. Sugar has not only been shown to have destructive effects on metabolic health, but new research shows that it can negatively impact learning, memory, impulse control, and metabolism as well, just to name a few things. Many of the medical conditions that plague adults, such as diabetes, cardiovascular disease, and fatty liver disease, are now being tied back to our diet—with sugar as the main culprit. Sugar is a silent killer. The damage that sugar causes isn’t obvious at first, and there aren’t always outward signs that anything bad is happening to your brain or body because of having too much of it. You aren’t going to drop dead from eating one cookie, but many years of having a poor diet that is rich in added sugar will not only reduce your life span, but it will also make it much more likely to be fraught with illness, disease, and unhappiness. The worst part about all of it is that, despite the fact that we know all of this, we continue to live in a world that is sugar-centric. Sugar is everywhere. It is pushed on our kids from a young age. It’s at the checkout line in almost every store. It is hidden in food products using different names. It is unavoidable. And if you happen to be one of the many people whose brain has been hijacked by it, you are stuck in the sugar vortex and probably feel like you can’t get out. Most people move on from their PhD dissertation and end up studying something else. I often tell people that, even though Princeton gave me my PhD degree almost twenty years ago, and my imposter syndrome has mostly cured itself, I am still working on my dissertation. There is so much more work to do. While I am still doing research, my focus has shifted toward helping people to understand the research, and to use it to their advantage. That is why I wrote this book. I have been inspired by the stories that people have shared with me of both anguish and success, and I want to help. I want to help you break free from your sugar addiction. I want you to have firstdegree access to the science so you can understand what sugar does to your brain, and how it can grab hold of your ability to control your intake. But more importantly, I want to empower you with the psychological and behavioral skills and tools that you need to break from the powerful hold of sugar and change your brain in a way that will change your life, forever.How This Book Can Help This isn’t a diet book. The last thing anyone needs is another diet book. This book is different because it’s a science and psychology book. The science is key to making logical sense of what you should and shouldn’t eat. I will talk about the studies, so for example, when you have a craving for sweets, you can remember that the hedonically programmed part of your brain is causing you to have that craving, not the actual need for food! The goal is to help you see that sugar is the culprit behind your overeating, your weight gain, and your unhappiness. Sugar not only messes up your metabolic health, but it also messes with your brain. By changing the way your neurons communicate, sugar traps you further into a spiral of addiction: bingeing, withdrawal, and craving. I will get into the neuroscience and the studies about this in chapter 3, but for now, know that sugar addiction is real, and it is screwing up your brain. But don’t worry—I can help you fix this. In chapter 1, I will review how sugar can lead to overeating, how our diet culture has damaged us, and how sugar has been linked to obesity and other mental and physical health conditions. Then, in chapter 2, I’ll review the latest research on the influx of sugar in the American diet, and discuss sources of sugar that people may not even be aware of (guess what? Your bacon has sugar in it! And so do your English muffins). This chapter will show you how easy it is to overeat sugar, even when you may think you are eating a low-sugar diet and making healthy choices. Next, in chapter 3, I’ll review the research on sugar addiction, beginning with my initial studies, and also the latest findings. I’ll explain how sugar can impact the brain in ways that drugs such as heroin or cocaine do. Then, in chapter 4, the real work begins. We’ll start to implement the steps to break your addiction to sugar. This chapter will lay out the Seven Simple Steps that readers can use to break their addiction to sugar and achieve sugar freedom. It will describe the steps, how to apply them, and how long each will take. After we assess the severity of your addiction to sugar, I will then help you to change your diet in a structured, simple way. The emphasis here is replace, don’t remove. I will show you how to systematically replace foods that you love with healthier alternatives so that you won’t feel deprived. The goal is for you to change your mindset completely around diets and food—you will not be “on a diet.” Instead, this is a new way of healthier eating that will be soon become your new happy norm. The next chapter is important because it will help you navigate common hurdles that people face when they give up sugars. In chapter 5, I will talk about some common foods that can help to make giving up sugar easier, including my ten Craving Crushing Foods—high-fiber foods to help regulate blood sugar and higher protein foods to help reduce cravings. Also, I’ll discuss triggers, and how to handle them. Then, I will review the research on sugar withdrawal and cravings and offer practical tips on how to manage these inevitable components of kicking a sugar addiction. Just like people who get addicted to drugs and alcohol experience withdrawal when they give them up, the same can happen with sugar. I’ll review how to cope with withdrawal and offer a timeline on what to expect. Cravings are a natural part of being human, but most people don’t know whether a craving is biological (i.e., we have low blood sugar, or low iron, and our body is physiologically in need of food), or something else. I will teach you about “hedonic cravings,” which are just cravings for the pleasure we get from eating foods, and how these are typically why we crave sweets. Don’t worry—I will also teach you how to survive them without giving in! Then in chapter 6, I will talk about how to live your new life, managing what I call the three S’s that are key to your success. These are: stressors, setbacks, and social pressures around food. Not knowing how to deal with these S’s will put you in a position that can lead you to relapse and go back to your old ways of eating. I will discuss the food environment and how we are essentially fighting an uphill battle to avoid sugar, thanks to the media, the food industry, and our own daily routines. This chapter will talk about relapses and provide psychological insights into why they occur, how you can avoid them, and what you can do if one happens so that you don’t feel you have failed and should just throw in the towel. This chapter will also describe some ways in which you can navigate social situations that involve food that can sometimes become awkward or pressure-packed. Are you ready? Let’s get started!
