Feel Better, Live More with Dr Rangan Chatterjee

“Health has become overcomplicated. I aim to simplify it” In this podcast, we hear stories from leading health experts and exciting personalities who offer easy health life-hacks, expert advice and debunk common health myths giving you the tools to revolutionise how you eat, sleep, move and relax. Hosted by Dr Chatterjee - one of the most influential GPs in the country with nearly 20 years experience, star of BBC 1’s Doctor In the House, and author of 4 internationally best-selling books, including ‘The 4 Pillar Plan’ – Feel Better, Live More aims to inspire, empower and transform the way we feel. When we are healthier we are happier because when we feel better we live more.

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#345 BITESIZE | Why We Are All Addicts | Dr Anna Lembke

#345 BITESIZE | Why We Are All Addicts | Dr Anna Lembke

Fri, 17 Mar 2023 00:00

CAUTION: Includes themes of an adult nature.

Do you think you have an addiction, or perhaps an unhealthy relationship with a certain behaviour?

Feel Better Live More Bitesize is my weekly podcast for your mind, body, and heart. Each week I’ll be featuring inspirational stories and practical tips from some of my former guests.

Today’s clip is from episode 222 of the podcast with Dr Anna Lembke, a professor of psychiatry at Stanford University School of Medicine and author of the book Dopamine Nation: Finding Balance In the Age Of Indulgence.

In this clip, Anna explains why we’re living in a world that’s turned us all into addicts and shares some practical tips to help us find the right balance.

Thanks to our sponsor http://www.athleticgreens.com/livemore

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DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

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Copyright © Dr Rangan Chatterjee: GP & Author

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Welcome to Feel Better Live More by size your weekly dose of positivity and optimism to get you ready for the weekend. Today's episode is brought to you by AG1 from Athletic Greens, one of the most nutrient dense, healthy supplements that I've come across. It contains vitamins, minerals, prebiotics, probiotics, digestive enzymes and so much more and I myself take it regularly. Go to Athletic Greens.com, forward slash live more to access a very special offer they are giving mylessness, five fantastic travel packs and one year supply of vitamin D free of charge with your first order. See your details at Athletic Greens.com, forward slash live more. Today's clip is from episode 222 of the podcast with Dr. Anna Lemke, a professor of psychiatry at Stanford University's School of Medicine and author of the book Dopamine Nation. In this clip, Anna explains why we're living in a world that's turned us all into addicts and she shares some practical tips to help us find the right balance. We're living in a dopamine overloaded world where everything has become drugified, everything has been made more accessible, more abundant, more potent, more reinforcing, more novel and so we're really living in a world that has turned us all into addicts essentially. 70% of the global deaths today are caused by modifiable risk factors. The top three are diet, lack of exercise and smoking. So we really have reached a tipping point when we are dying because of our behaviors and I really do think that the problem of compulsive overconsumption or addiction is the modern plague that we will be dealing with for the next hundreds of years. Given how important Dopamine is, well, one of its functions, as you say, is our pursuit of pleasure. You say it's intimately linked with addiction. So where is that sweet spot where we can use it to gain pleasure, gain those rewards that we all want without it tipping over into addiction. I think that really, I think, underpins a lot of your book, doesn't it? This balance and this sweet spot because we find it hard. Yeah, yeah, no, you're right. It's really important to understand that pleasure and pain work like a balance in the brain and that the same parts of the brain that process pleasure also process pain. So if you imagine that in your brain there's a balance like a teeter totter in a kid's playground, okay? And when we experience pleasure, it tips one way and when we experience pain, it tips the opposite way. And one of the overarching rules governing that balance is that it wants to remain level. It doesn't want to be tipped for very long to the side of pleasure or pain. And our brains will work very hard to restore a level balance or what neuroscientists call homeostasis. So when we do something pleasurable, okay? So in my case, that might be reading a romance novel or eating a piece of chocolate or my morning cup of coffee, what happens is that I get a little release of dopamine in a part of our brain called the reward pathway. And my balance tips to the side of pleasure. But no sooner has it done that than my brain will try to restore a level balance by downregulating dopamine production and dopamine transmission, not just to baseline levels, but the low baseline levels. And I imagine that as these little gremlins hopping on the pain side of the balance, that bring it level again, but they like it on the balance. So they stay on until it's tipped in equal and opposite amounts of the side of pain. That's the come down, the after effect, the hangover or that moment of wanting, you know, one more cup of coffee or, you know, wanting that novel not to end or wanting to watch one more episode. Now, if we wait long enough, those neuroadeptation gremlins hop off and baseline dopamine levels are restored. But if we don't wait, if we continue to consume our drug of choice repeatedly over days, two weeks, to months, to years, we end up with enough gremlins on the pain side of the balance to fill this whole room. In other words, we end up with a pleasure pain balance that has a new, hedonic or joy set point. It's now chronically tilted to the side of pain because those gremlins are camped out there. And we are in a dopamine deficit state. In other words, to compensate for the increase in dopamine in our brains reward pathway beyond what our brain has evolved to deal with, we essentially go into this chronic dopamine deficit state. And once we're in that state, we are struggling with the addicted brain. And then we need our drug not to feel good, but just to restore a level balance and feel normal. But that sort of idea of a seesaw and we move to the side, we have our drug of choice. And as we're going to talk about, this doesn't necessarily need to be alcohol or cocaine. This can be sugar. This can be coffee. This can be Instagram. And so we press on pleasure on the seesaw. And you're saying that actually the body then responds by the seesaw goes in the other direction to move us to try and recreate balance. But if we keep doing this day in day out, the seesaw gets stuck. And actually we're just left craving all the time. We want we take any dopamine hit just to get back to normal. That's right. So in the world in which we live, what are some of the things that you find people are probably addicted to? But because they're normalizing society, often people don't actually think of them as addictions. I have the one that's off of my head. I think a lot of the world is addicted to caffeine in a big, big way. Caffeine is certainly way up there. Alcohol is so ubiquitous and so normalized. And I think many, many people use in ways that are not healthy, but are able to tell themselves that their use is okay. I would also put really high up on that list. A lot of digital products and devices. And I would put up their work, addiction to work. It's so socially rewarded. That sort of 24, 7, I'm on it. I'm reachable wherever you want to find me, high stress. When we add a shot of adrenaline to something that also releases dopamine, it makes it even more reinforcing. There's a fascinating study looking at rats. If you inject a rat with cocaine, slice open its brain, what you'll see is this incredible arborization of dopamine releasing neurons in the reward pathway. If you take a rat and subject it to an intense, painful foot shock, you will see the identical arborization of dopamine releasing neurons in the reward pathway. In other words, we can actually probably get addicted to highly painful stimulus too in the form of work or news. That's why doom scrolling kind of comes in. So there are lots of things that I think are socially sanctioned. You know, again, I think work is probably, I would put at the top of the list that we kind of don't acknowledge even my own attachment to my email. So I'm not on social media. But I have to really watch myself with my email, which is sort of my work sanctioned social media. You know, I try to take a digital Sabbath once a week and it's really hard. But by the end of that day, I don't even want to go back to using because what I'll notice when I go back to my email is I'll answer the emails that need answering and then I'll linger. I don't want to leave it. I'm sort of waiting for something good or reinforcing to come in or I'm continue to scroll through and read the things I've read before, you know, as a way of kind of making myself feel like, okay, I still need to be here in this space. But really, I don't. I should just get out of my email and move on to the next thing. And I've developed some tricks for coping with that, but it's really hard. Yeah. I mean, what you're speaking to as well is ease of access. How easy it is to access clearly makes a huge difference. And I guess work, again, going back 20, 30 years ago when we didn't have email or the abilities to have email in our pockets. You know, when you left the office, you were probably barring in emergency where someone phoned your landline. You were probably kind of done, right? You would, you would naturally be able to switch off. And I think there's been this insidious creep. I think with technology for me, it's about, it's about intentionality. We're not really asked ourselves or many of us. What do we want this smartphone for? We take it with like, it's the sweet shot with all the goodies on it. And it's kind of like, well, why don't you think about what do you want from it? Okay, I want to be able to make calls. Okay, great. You want to be able to make text messages. Okay, great. Right? What else? You might want to listen to music. Okay, you know, and actually introduce the apps that you want that are going to enhance your life rather than the make you a slave. And I guess that email piece is, if you don't have email on your phone, it's just a hell of a lot easier to not be checking your working emails at the weekend. Right. Yeah, which gets to one of the, you know, so dopamine nation is not just about the problem. It's also about what we can do about it. And one of the recommendations in addition to the dopamine fast is these self-binding strategies, which is essentially creating, creating literal and metacognitive barriers between ourselves and our drug of choice, exactly what you describe. If we make it harder to access our drug of choice, that little bit of a pause is often just enough to make us to allow us to decide not to use in that moment. And that's really, really important. The first intervention when I have patients come in with depression, anxiety, insomnia, and attention, I say, let's eliminate your drug of choice, whatever it is, whether it's social media, video games, cannabis, we're going to take it away for a whole month. Why a month? Because a month is typically the minimum amount of time it takes for the brain to restore dopamine levels back to healthy baseline. I also warn them that in the first two weeks of abstention or the dopamine fast, they're going to feel worse before they feel better. Why? Because those gremlins are camped out on the side of pain and they're in a dopamine deficit state, which means when they're not using their drug, they're in withdrawal. So I tell them you're going to be more anxious, more depressed, restless. You're going to have intrusive thoughts of wanting to use your phone, play video games, use cannabis. But if you can just get through those first two weeks by weeks, three and four, the light really does come out and you will notice yourself feeling better. But almost universally, that is what happens. I've been doing this for 25 years. So I really believe that this works because I have a huge sample. Now, Rongan, you know that abruptly stopping your drug of choice is not something you would recommend and somebody who's at risk for life threatening alcohol withdrawal, benzodiazepine withdrawal or opioid withdrawal. Those individuals may indeed need medically monitored detoxification in order to get into a dopamine fast, which means that they might need a slow taper or another medicine to prevent life threatening withdrawal. But for the vast majority of us, stopping in Turkey is perfectly fine. You know, patients will say it's hard, but they definitely have reduced anxiety, depression and insomnia all of it at a month. Not only that, they have insight because now they're able to really look back and see the true impact of their use on their lives, which is really hard to do when we're in it. And so, only by changing something in that biological system, forcing our brains to restart to regenerate our own dopamine, that we can look back and say, oh my goodness, that's surreal. I can't believe I was so invested in that. And that I think is a second critical point because that's empowering for an individual, isn't it? That gives us a sense of control, a sense of agency that, oh, I get it. When I engage in these behaviors, my mood goes down, I get depressed, I get anxious. When I come off it, I feel better. When I restart again, I get worse. And it doesn't mean you're going to get, certainly through what I've seen. It doesn't mean the first time you're going to get it right. You're going to stop and then you're all good. No, but it's a process of education each time and every time you go back, you keep reminding yourself, oh, do you know what? I feel better when I'm actually not on this stuff. That's right, and I always frame it to patients as an experiment. Yes. If you know what, you're the scientist. This is the experiment called your life. Let's gather data. The best way to know how to assist, how a system is working is to change something in that system and see what happens. So the experiment that we're going to do is you're going to eliminate this drug for a period of time and see what happens. And my hypothesis is that you will feel initially much worse because you will be in withdrawal and craving. But if you can make it a long enough period to restore homeostasis, you will feel better. And when patients see that for themselves and experience that for themselves, I no longer have to convince them that it's a worthy project. I think many people will have resonated with so many elements of this. It would have heard little bits and thought, man, maybe I've got an unhealthy relationship with X, Y or Zads. For those people who are now questioning their relationship with X, and maybe we're calibrating it. I wonder if you could give some sort of final words of wisdom for them. Yeah. First of all, don't be hard on yourself. Compassion is key. But don't give up. I think that's probably the bottom line. We can make our lives better, especially when we understand the source of our suffering. And the real point of dopamine nation is that paradoxically, a major source of our suffering may be the very things that give us so much instantaneous pleasure. So by eliminating those things, to the extent that we're able for long enough for our brains to recalibrate, I really do believe that that will be in a harm moment for a lot of people. I hope you enjoyed that bite-size clip. Do spread the love by sharing this episode with your friends and family. And if you want more, why not go back and listen to the original full conversation with my guest. If you enjoyed this episode, I think you will really enjoy my bite-size to Friday email. It's called a Friday 5. And each week I share things that I do not share on social media. It contains five short doses of positivity. Articles or books that I'm reading, quotes that I'm thinking about, exciting research I've come across and so much more. I really think you're going to love it. The goal is for it to be a small, get powerful dose of feel good to get you ready for the weekend. You can sign up for it free of charge at doctorchastity.com forward slash Friday 5. I hope you have a wonderful weekend. Make sure you have pressed subscribe and I'll be back next week with my long form conversation on Wednesday and the latest episode of Bite-Simes next Friday.