#24 – Metabolic Health and Addiction
SUMMARY KEYWORDS
metabolically, eating, addiction, metabolic, food, people, processed food, disorders, health, patients, brain, glucose, problem, healthy, ketones, sensitivity, speculating, sugar, insulin, dopamine
SPEAKERS
Jack Heald, Dr. Philip Ovadia
Jack Heald
Well, Happy New Year. This is the Stay Off My Operating Table with Dr. O. Let's try that again. Well, Happy New Year. This is the Stay Off My Operating Table podcast with Dr. Philip Ovedia. I'm your co-host, Jack Heald Dr. Ovadia, good to see you, again.
Dr. Philip Ovadia
Great to be with you back with you, Jack, I think we had a very successful season one, and I'm excited for what season two is going to bring.
Jack Heald
I am too. We've got some really good subjects in line. We've got some good guests lined up. So let's just jump right into it. You and I were talking offline a couple weeks ago, and the subject of addiction and metabolic health came up, and my ears perked up, because addiction is a problem that plagues a lot of people. And you just kind of commented on metabolic health can help with addiction. So I said, “Hey, Doc, we got to talk about that.” So let's do that. Let's talk about how metabolic health or lack thereof, and various forms of addiction are connected.
Dr. Philip Ovadia
I think it's a great topic for us to dive into and very timely. I was one of the speakers about a week ago at the Low Carb USA conference. And while my talk focused on heart disease risks, and metabolic health, there were a number of talks that were focused on various aspects of mental health and their relationship to diet and metabolic health. So I think it's a very timely topic to be discussing. And the other unfortunate trend that we are seeing in society is that there is a worsening of mental health. Things like suicide and drug abuse are clearly on the increase. And that's obviously due to a number of societal factors these days. But I think it's very important to start discussing what we can do to improve that. And I think improving metabolic health is clearly something that can help with mental health issues.
Jack Heald
Well, let's start with a type of addiction that is comparatively recent: eating disorders. I'm thinking of anorexia, bulimia, those types of disorders. Now, I realized those may actually be mental health disorders rather than then have a physical connection. But is there a connection between metabolic health and those kinds of eating disorders? And will increasing your metabolic health make a difference?
Dr. Philip Ovadia
Yeah, so this was actually the topic of one of the talks at the meeting, and a dietitian gave an excellent talk on this very topic. At first, it would seem to be counter intuitive that the way to fix an eating disorder, such as anorexia or bulimia is to restrict what the person is eating. But in reality, this speaker and many others were able to relay personal experience, as well as their professional experience in working with clients and patients, that they have seen significant improvements in eating disorders, when the focus was on the quality of the food you're eating. At its root that's what we're talking about around metabolic health. You know, I think the main focus of my messaging is to be eating better quality food, to be eliminating the processed foods, eating whole real foods. And we see that has a noticeable impact on people's mental health and on things like eating disorders, and there's very good, scientific, biochemical reasons why that would be true. And we can sort of get into the effects on brain chemistry that come from metabolic health and from eliminating processed foods.
Jack Heald
In other work that I do, I've spent a lot of time studying brain chemistry, so I'd appreciate it if you I think I've got to at least a relatively educated, layman's understanding of some of the neurochemical processes involved in our brains and how it affects behavior. Can you talk a little bit about that?
Dr. Philip Ovadia
Yeah. So we know that similar to all of our organs, our brain can utilize two primary fuel sources. And those are glucose, which is sugar, and ketones, which come from the utilization of fats for energy. What we see happen in many of these mental health disorders is that there seems to be alterations in the brain's ability to process glucose. And when people are eating, let's say, standard American diet, a metabolically unhealthy diet, they are usually using primarily glucose as their fuel source, because of the hormonal environment that set up by eating that type of diet, they are unable to burn fat and generate ketones for energy. And that's one of the central problems with poor metabolic health, it seems that the brain better utilizes ketones. And when your brain and your body for that matter are primarily working off of ketones, or at least have that flexibility of easily switching back and forth between glucose and ketones as their primary energy source, that is an advantageous situation. So again, when we get metabolically healthy, we tend to rely more on ketones for energy than glucose. That is a more stable, more long-lasting sort of energy source ketones, as opposed to glucose, which is a very kind of fast burning energy source and tends to have a lot of ups and downs. That and those up and downs are what seemed to contribute to a lot of mental health problems.
Jack Heald
I realized you're not a brain doctor. So maybe this is an unfair question. But as I think through what you just said, these eating disorders like anorexia, bulimia, The speculation is that it has something to do with the I want to make sure I've understood your statement that I'm going to ask a question, assuming I've understood these types of disorders are highly correlated with a dysfunction in the brain's use of glucose as a fuel source. Did I get that part? Right? Yeah. So
Dr. Philip Ovadia
I'm not a brain specialist. Mental health disorders in general, have been correlated with metabolism of glucose. To be honest, I'm not sure that eating disorders in particular have shown that same evidence. But as I said the clinical evidence that people have seen not my particular area of expertise, but the people who deal with eating disorders, they have seen good clinical response to eliminating processed food and improving metabolic health for people who are suffering from eating disorders.
Jack Heald
Wow. So just, I'm just speculating wildly here with my layman's understanding. So people who, who are anorexic, just simply don't eat enough, don't get enough calories, period. I know that at some point. When you're not when you're not ingesting carbs, your body will flip over and start burning fat. But one of the problems with one of the single biggest problems with anorexia is you burn off everything you use up all your fat, and then the body starts eating muscle, I think I think that's how it works. So that would imply at some point, the, the brain itself is literally starved of all forms of fuel. There's no glucose on board you've chewed up all your fat for basic processing. And, and the brain is starved of fuel, which clearly would make your thinking completely messed up. And I'm and I just speculate here have I got that? Am I Am I the right neighborhood there?
Dr. Philip Ovadia
You know, certainly, with anorexia, in particular you're going to be dealing with a kind of malnourishment situation. And the controversy becomes - and this, again, was one of the topics that was discussed at the conference, the controversy is how best to the clinical term is "re-feed these patients. Probably not a great term to use, but when you are trying to get them to eat again, and eat normally, what is the best way to do that. And the theory that this speaker was putting forth that I think makes a lot of sense, is if you do that using whole real food, that are going to promote more fat burning, sort of a ketogenic diet, essentially, that, that may be a better way to go about it, which is very much against the traditional approach to these patients these days. You know, one of the things that was talked about is oftentimes, you need to resort to tube feeding, artificially feeding these patients, because they won't eat. And the tube feeds that are used in hospitals these days, are basically just a liquid version of the standard American diet, they are very high and in sugar and carbohydrates, they use a lot of the vegetable and seed oils that are found in processed foods. And again, it, it would make sense, and there has been clinical evidence that if we can refeed these patients on a whole food whole real food diet, a ketogenic diet, that that maybe a better way to do that, because you're not going to keep furthering that cycle of getting into this sugar burning with the while variations in glucose levels within the brain itself.
Jack Heald
Fascinating. So, at a very specific diagnostic level, we can't do any kind of diagnostics here. But what we can, what we can say, for someone who's concerned about that particular problem, rearing its ugly head, is get the processed food out of the house, get the box food out of the house, get the early the prepared food out of the house, just don't have it available. Stock, the stock the house with nutrient dense, whole real foods, as a start, there may be more needed than that, but do that as a start? Right.
Dr. Philip Ovadia
I think that's well said. And I think as we broaden that out to more generalized mental health issues, we start to see similar things.
Jack Heald
Yeah. And I guess part of what we get into here is that that murky gray boundary between the body and the mind and which comes first the chicken or the egg? Not really our job to untangle that knot.
Dr. Philip Ovadia
I can certainly say, based on my personal experience is that I clearly had some issues, that - addictive food issues I guess could say - when I was eating processed food in the standard American diet and what I have found since I improved my metabolic health and have eliminated processed foods and stick to eating whole real food, is that those food addiction issues are no longer present. Now one of the arguments that sort of goes on is, "is it the food itself that's causing the addiction, these highly processed foods with sugar and the highly processed carbohydrates? Do they themselves cause addiction, food addiction? Or "are people that are more food prone to food addiction, also more prone to eat those foods?" There is some discussion to be had there. But you know, what I personally have seen, what many of my patients describe is that when they eliminate processed food, when they eat whole real food, when they become metabolically healthy, those addiction issues around food get better
Jack Heald
Fascinating. Well I've never had any kind of addiction that I could recognize with the possible exception of when I was day trading index futures. And that's a, that's another issue. Having said that, as someone who hasn't dealt with any kind of addiction issues, I've proven for myself that eating whole real foods changes what I get hungry for. And that's a result of that, as a result of, of working with you these last several months, you've your advocacy of, of whole real foods, pushed me over the edge to the point where I, we've gotten rid of all the not whole, not real foods in the house. And as a result, I eat better, obviously. And at the same time, the craving for that junk. I'm one of those crunchy-salty, guys give me the crunchy-salty, and I'm just "keep giving it to me!" Those, I wouldn't call it "addictions," but certainly "cravings" have completely disappeared. I just, I don't crave that stuff. So anecdotal evidence, I understand, but, but there it is, nonetheless.
Dr. Philip Ovadia
And again, looking at the high-level picture, it's hard to believe that we would have evolved in such a way that foods that are good for our body, are going to be bad for our brain, or vice versa. You know, so I think it makes perfect sense at a high level that when we are getting back to eating these foods that nourish our body, that keep our body healthy, that that is going to have positive effects on our brain as well.
Jack Heald
This makes me think we should get an addiction expert on just to talk about the biochemistry of addiction. And maybe have you guys rub brain cells together to come up with some, at least some interesting theories. So does the same thing hold true for other kinds of what are clearly physical addictions? Drug addiction? Cigarettes? Alcohol? Yeah, I guess those are kind of the big three.
Dr. Philip Ovadia
Yeah many of the practitioners in the metabolic health space in the, in the community have noticed exactly that patients come to them for their metabolic health issues. They want to cure their, they want to reverse their diabetes, for instance. But in the process of doing so, they give up drinking, they give up smoking, they give up things like gambling, or pornography. This is something that a lot of us have noticed, in the space as we're dealing with these people. And as we are helping these patients, again, that it's just, there seems to be I describe it as a stabilization of mood that goes with being metabolically healthy. It is consistently reported. And this is something I've noticed myself, this is something that many of the patients I work with, have told me, and you know, the other practitioners that I interact with hear the same things from their patients as well, that they just don't have those mood swings. When you're metabolically healthy, you don't get that hangry feeling that many of us are so familiar with. And you just, again, for whatever reason, and it probably has to do with the brain chemistry and running on ketones versus glucose, and the more stable levels of those fuels that you can accomplish over time. People consistently notice that their, their mood just is more stable, and they're not prone to those ups and downs. And I think there's a lot of reason to believe that those ups and downs are what get people you know, in those addictive type behaviors because it you know, they need those ups from other things as well. It might not be coming from food for them. It might be coming from something else, like cigarettes or alcohol or gambling or pornography, or any of these things that people can get addicted to.
Jack Heald
So if we think about it neurologically, neuro chemically, the neuro chemical That seems to be most involved in addiction is dopamine. Dopamine is what mediates our, our, our feeling of accomplishing something. So that's why these things like Twitter and video games have become so addictive is because they, they give the false sense of getting closer to a goal. And that feeling of pleasure that we get as we see ourselves approaching a goal, at least neurochemically is caused by the release of dopamine. And I know that that's at why I don't know, because I've studied it, but because people I trust say that that's essentially what cocaine does cocaine stimulates the dopamine production in the body. And that's what makes it so addictive is that you get the dopamine spike without actually doing anything. It's just this massive dopamine dump. And, in fact, I think they say that part of the problem with cocaine is that it oversaturates your, I guess, your dopamine receptors in your brain. And you never quite get the same feeling of satisfaction about anything after having after having a cocaine addiction. So having said all that, I'm just thinking things through here and stop me if I'm going way off path.
Dr. Philip Ovadia
Well it brings up an interesting point, because one of the things that has been shown in repeated kind of studies is that sugar is actually more addictive than cocaine. And they've shown that sugar lights up similar areas in the brain that cocaine does. And there's a kind of famous rat study that's, that's referred to, often that basically showed that rats become more addicted to sugar than they do to cocaine. So, it's, there's, again, a lot of reason to think that the types of food that we're eating are going to have an impact on our mental health and on addiction issues, and that by improving your metabolic health by improving what you're eating, you will be able to see improvements in these other mental health issue, as well.
Jack Heald
Yeah, so I'm just speculating here as a as a complete layman, but I'm speculating. I know that. What happens metabolically in our, in our digestion, in our energy production system, when we're dumping too much processed carbs into our system, we overwhelm our insulin receptors. And so the problem the problem becomes insulin insensitivity. And so our pancreas needs to create more and more insulin. And it's we get into this vicious cycle. And at some point, the pancreas just poops out and says, I can't make enough anymore. And we've now reached the point where we end up not making we have our blood sugar shoots up because it's not being transferred into the cells via the mechanism of the of insulin. I've got that right. Don't die. I've got that bit, right.
Dr. Philip Ovadia
Yes. Yeah, that was a good, good summary of it.
Jack Heald
So now the speculation on so what I'm speculating is, are these addiction issues? Are they dopamine related? And have the same sort of issue that we have with insulin? Is it a dopamine receptors overload do we do we become dopamine insensitive, and is getting metabolically healthy? Something that they it, perhaps what's happening is the dopamine, dopamine receptors are getting a chance to rest and recover and regain their sensitivity in the same way that our insulin receptivity improves, as we as we eat better. I know, you don't have an answer. I'm just I'm speculating here.
Dr. Philip Ovadia
No, it's a very interesting concept. And I don't know how much science we necessarily have around that. But one of the things we do know, for instance, with addictive behaviors is that over time you need more and more of whatever that stimulus is usually to get the same effect.
Jack Heald
Exactly. It's an analogue with insulin.
Dr. Philip Ovadia
Yeah, exactly. And again another kind have personal experience around getting metabolically healthy is, for instance, I noticed that I'm much more sensitive to the effects of alcohol, and what used to take three or four drinks to get me to a certain level now one or two drinks can do that. And that is another consistent finding that I see and peep that I hear from people who are improving their metabolic health. And so again, it might be a similar, similar situation. And then I'll take it one step further, with even when you look at your sensitivity to taste what, now that I have metabolically healthy, things that never seem sweet to me before, seem very sweet now, or very low levels of sugar, are very sweet tasting now, whereas when I was not metabolically healthy, and I was eating all this stuff on a regular basis, it would take a lot more sweetness for me to perceive it, I guess you could say, so, yeah, um that that's along those same lines, I think metabolic health gets all of our cells working better. And when it comes to sort of sensory type cells, I think that holds true as well. And so it's just one of the one of the many aspects that we see improved with metabolic health improvement.
Jack Heald
I've got another question, I want to want to ask you about really guarding sensitivity to bad foods, after you've been eating good foods for a while, but it's not actually in the, it's not in the addiction category. You know, what, this is a conversation, let's have the conversation. I was talking to my mother this morning, she's read your book. She got serious about dumping the junk from her diet. And for I would say, a couple of months now, she's been eating primarily a Keto-type diet. Excuse me. And she's commented here just in the last couple of weeks. You know, we just got through the holidays, and my daughter in law had her birthday, and we had a big blowout for that. Mom had probably more processed wheat than she's had, in quite some time. And it's not a lot, but it's a little bit. The other thing is she's discontinued dairy for a different set of reasons. And she's she commented this morning that she's noticed she's far more sensitive to the effects of both flour and dairy than she was before the negative effects. I'm guessing that, once again, it's the same category of response, a heightened sensitivity. As a result of stopping the abuse, insulin receptors are heightened in their sensitivity when we stop abusing them. I speculate that neuro chemical receptors are heightened in their sensitivity when we stop abusing them. And the inverse is what I'm describing, with my mom a heightened sensitivity to the negative aspects of the of the abusive food. Can you talk a little bit about that, and in other words, I'll give you a for-instance: milk causes her to have a histamine reaction where she sneezes and gets stuffy or runny nose, mucus production, that kind of thing. And she's largely eliminated it but has a little bit now and then and said, she seems to be it doesn't take very much to trigger those kinds of responses. Now. I don't know if I'm making myself clear, but I'll throw in your lap.
Dr. Philip Ovadia
It so I think there are two aspects of that. The first is what you know. I think as people become metabolically healthy, they realize what they're actually supposed to feel like. And people who are eating you know, processed food all the time. Feel bad all the time. They just don't realize that they feel it just don't know it because they feel bad all the time. And once you know, eliminate the processed food and you get metabolically healthy, and you notice how good you're supposed to feel. And then you know, you go and you eat some processed food and it makes you feel bad. And you know, now you actually notice it, and this shows up in different ways for different people there'll be people who a particular joint might hurt their knees always hurting, and they eliminate the processed food, and they feel better, and their knee pain goes away. And then they eat a little something on an occasion, and they feel it in their knee. And it's like, okay basically, the process food was always causing you to feel bad. You just never noticed that because you always felt bad. So I think there is that part
Jack Heald
of it. Okay, well, that makes sense. Interestingly, what
Dr. Philip Ovadia
I do see in many of my patients who have dairy sensitivities, even those who sometimes you know, have gluten sensitivities, is that when they get further along in the process, and now they're truly metabolically healthy, all the inflammation in their gut that goes along with metabolic disease has settled down, a lot of them can get back to those foods that they weren't able to tolerate in the past. Not all of them, but a lot of them, I do see this width. So I think there's kind of stages to this, I would say, but exactly what you notice with your mom I had a, I was doing a telemedicine visit with one of my patients who recently joined the practice. And she's been she's now three or four weeks into eating clean and eliminating processed food. And she said to me, oh, the other night, I kind of slipped up. And we decided to order a pizza, and I had a few slices of the pizza. And I noticed how horrible I felt afterwards, and she said, I always used to eat pizza. And I said, well, you know exactly what I just said that you probably didn't notice how bad it was making you feel because you always felt that way. Because you were always eating processed food. Now that you feel better and you're metabolically healthy, you really notice the effects of that.
Jack Heald
So it's not so much that you feel worse than you used to feel. It's that you get used to feeling good. And when you feel the way you used to feel. It feels worse, because that used to feel like normal to you. And we just adapt to whatever our conditions are. And so we get used to our new normal and the old normal feels worse. I think I've got that. Yeah. Okay, that makes sense. Alright, so we've talked about possibly mental health problems such as eating disorders, we've talked about chemical problems, such as drugs, alcohol, we've talked about those fuzzy areas, which are maybe brain chemistry problems, like pornography and gambling. Are there other types of addictions? I guess the other one was, would be smoking, which, as I understand, is both a physical and a behavioral addiction. All of these, you're saying there has been at least anecdotal if not clinical evidence, that getting metabolically healthy? Helps. Is that correct?
Dr. Philip Ovadia
Yeah, I would say that's correct. And like I said, on the high level, it just makes sense that when we get our bodies healthier and working as they should, it's going to help our brains get healthier and work as it should.
Jack Heald
Okay, I've got a question for you. That I'm not i I'm concerned about how you're going to answer this but we're going to ask the question. I have a friend who is I would say by and large, a health fanatic. For the last couple of three years he has eaten very clean. He's become a very good chef. He cooks all the all the food for his for himself and his family. I don't think they buy anything out. Everything is made at home. It's whole real food is what he eats. He works out like a fiend. He has a one of those dry sauna things in his house, where he'll sit. It's like 140 degrees and he sits in there and does this regularly. He takes supplements to help him with everything. In other words, he does all the things you're supposed to do. And by all appearances, he's wildly healthy. There is this one thing and these are his words. He drinks like every day is the apocalypse. He's in the entertainment business and so he works entertainer’s hours rather than normal human being hours. And drinking is just kind of part of the part of the thing. And I go back and forth with whether I should worry about the amount he drinks. Or if maybe everything else he does is offsetting that. Alright, so that's the story. The question behind that is, is his pretty radical level of health. Otherwise, just helping him to deal with all the alcohol, he pours down his body. He doesn't appear to have a problem, other than just the quantity. He's a big guy. So he so it takes a lot to, to get in there. But his own words are he drinks every night, like it's the apocalypse. And I can attest to the fact that he does. But it doesn't seem to have any effect on him. Every now and then he'll stop drinking, just to see if he can do it. And he can, he doesn't seem to have withdrawal or any of that stuff. But he drinks like a fish. And I just thoughts, comments, questions?
Dr. Philip Ovadia
Yeah I mean, it would be interesting there were certainly would be some things I would want to look at his liver function tests and such. But yes, I would certainly say that being metabolically healthy, is going to allow you to maybe tolerate a little better insult to the system will say, then then other people, then people who are not metabolically healthy, and using those same toxic substances. I mean, unfortunately, in the end, we can't get around the fact that alcohol is toxic to our bodies. And it's not something that we're really meant to be consuming, I would say, on certainly on a regular basis in large quantities like that. So, I guess if I was having a conversation with this person, I would say look how good your health is. And it could probably be even better if you weren't drinking so much alcohol.
Jack Heald
Yeah, yeah. Well, I think he'd be an interesting study. I really do. Maybe I can convince him to get a liver function test. Just to see what the heck's going on. Otherwise, he's wildly healthy. He, he climbs we've got mountains here in Phoenix, and on, I think every day, he climbs Camelback Mountain, which is a heck of a hike. Anybody who's done it understands that's, that ain't nothing. That's definitely something that his, I would guess his body fat is low 20s High teens, he's, he's younger than I am. But past middle age. He's gonna kill me if he hears me say that. So he's been a puzzle to me, that's really been a puzzle. I just I hadn't been I've known what to make of his otherwise extraordinary health and the sheer quantity of alcohol he's able to put away. So alright. Well, I think I've, I've run out of questions about addiction. Have you got anything else you want to add? Any anything we haven't addressed?
Dr. Philip Ovadia
No, I think that was a good discussion around this topic. You know I just would reiterate that focusing on your metabolic health, improving your metabolic health is not only going to improve your body, but it's going to lead to improvements for your mind as well.
Jack Heald
And probably your relationships frankly, would you feel better, you tend to get along with people better? Alright, well, this is the time that I say hey, go ahead and subscribe to the podcast. There's a new episode of the Stay Off My Operating Table podcast that drops just about every week on Tuesdays. You can follow Dr. Ovedia on Twitter at “IFixHearts.” You can get more information about the type of telemedicine he practices if you need help getting your metabolic health straightened out. I suggest you look him up at OvediaHeartHealth.com. And I think that'll do it for today. We'll talk to you all next week.