Hey there. It's Dr. Susan Peirce Thompson and in this week's vlog, I have a provocative question for you. Do the new weight-loss drugs treat sugar addiction? I'm going to answer that question in this vlog. First of all, what does it mean to treat addiction? I think we need to start there. What is addiction? Well, for our purposes here, I think we want to narrow addiction down to obsession and compulsion.
When you have thoughts, people are talking about this a lot these days, the food noise, that is the mental obsession of food addiction. In some people it gets really, really strong. With sugar, it would be the thoughts of sugar, the planning to get sugar, the thoughts of specific types of sugar, having sugar in the house somewhere and feeling like it's calling to you from the freezer, from the cupboards. That's all mental obsession. And then the compulsion to get it. This could be the compulsion to drive across town for it, to scroll through an app and order it, the compulsion to get to the grocery store for it, or just the compulsion to keep consuming it once you start. So, you're eating chocolates in a box of stuff, and you've had one and you said you were just going to have one, but now you're having another and another and another. So, obsession and compulsion. Treating that would be lowering it, right? Removing it, taking away the food noise either quite a bit or altogether and taking away the compulsion. So, restoring the ability to not have any at all, maybe to have a little and then stop that would be treating the sugar addiction. So, do weight loss drugs treat sugar addiction? I'm going to say yes and I'm going to give it a qualified yes.
There are a lot of caveats and asterisks to this yes, and I'm going to explain them. First of all, let's talk a little bit about the neurobiology of how sugar addiction develops. In the mesolimbic reward pathway, this is the deep center of the brain that evolved to make sure that we have the drive, the motivation to go get what we need to survive, this is mainly sex and food, this is the ventral tegmental area and the nucleus accumbens driven by dopamine signals. What happens is that processed for refined sugar that exists today, and even like honey in its natural form, things like that, way overtake these receptors. These receptors really do well with moderate food rewards, regular foods that you would get if you were a hunter gatherer a hundred thousand years ago, maybe that's too long, like 10,000 years ago, whatever. Shoot, like 500 years ago. But anyway, today we've got different things. We've got convenience stores today. We've got bags and boxes and pints and ultra-processed foods made with intense quantities of sugar that have the effect of flooding this mesolimbic reward pathway with excess levels of dopamine that are incredibly high. Then the dopamine receptors over time respond by becoming less responsive, and they're trying to restore homeostasis. They're trying to be smart and adaptive, and they are in their way. But what happens is that the dopamine receptors become less numerous and less responsive. It's called dopamine downregulation. Once that happens, once you've wired the brain in that way, now you need a lot of repeated exposure to high dopamine reward foods or other activities or substances, this is why cross addiction is so common, just to feel okay because you don't have enough dopamine receptors active enough at baseline to feel normal, just to feel robust, happy and healthy. You need dopamine hits just to get through the day. This is why we get into a two-hour pattern of stopping at a cafe or going to a vending machine and needing that food at intervals all day long. That's how we've changed the brain.
How do these weight-loss drugs fit into this picture? Well, what the weight-loss drugs do, and we mostly have studies in rodents around this because we can't actually look at human brains quite the way that we can look at rodent brains in terms of neuroscience, but there's about a hundred studies now looking at weight-loss drugs and the reward system. Just a little sidebar here, the weight-loss drugs mainly affect appetite. That's a separate pathway. That has to do with slowing digestion. It has to do with insulin and glucose levels. That's diabetes. That's appetite, that's separate. I'm talking here now about the reward system. Weight-loss drugs affect the reward system profoundly. A hundred studies in rodents showing this. This is why you'll hear people who are on the weight-loss drug saying, "Huh, I lost interest in drinking alcohol." "Huh, I don't drink caffeine the way I used to." "Huh, I'm not smoking cigarettes anymore." And it's easy for them. It's just taking it away. So, what about sugar?
Well, let's talk about how the weight-loss drugs affect that reward center. What they actually do is they blunt the dopamine spike, the surge, the flood that I was talking about, meaning the next time you eat something that's highly dense with sugar and incredibly rewarding, you're not going to get that dopamine surge anymore. It takes away the hit. It takes away the reward value of it. It leaves baseline dopamine alone, but it doesn't fix it. It doesn't heal the baseline dopamine of those receptors that are already downregulated. Now, this is an important point. We're going to get back to it, but it does take away the spike. What that means is that someone who's on a weight-loss drug finds themself a lot less interested in pursuing a hit because the hit's just not available. It's not there anymore. They're kind of like, "Eh." So, in my book, that's treating addiction. It takes away the food noise and it takes away the compulsion to get a hit. That sounds to me an awful lot like a treatment for sugar addiction.
Now, let's look at some of the asterisks because there are a lot of them. First of all, weight-loss drugs don't work for everybody, meaning first of all, that some people get on them, and they find the side effects so intense that they have to get off them right away. I mean, typically gastrointestinal side effects, but some people just suddenly they're vomiting nonstop, their diarrhea is out of control. Typically, if you can start on the medication slowly enough and you can hang in there on the medication for about three months or so, a lot of the side effects soften. Some people manage to stay on them. Some people don't have those terrible side effects right from the gate, but the drugs don't work for everybody. They just, not everybody finds that they agree with their body. So, that's one asterisk.
A second issue is that people are reporting that they're on the medication for a period of time having great results, able to eat sugar in moderation and then they find that something emotional happens in their life like life gets lifey, something upsetting, right? A fight with their partner, someone at work hugely disrespects them. They get upset and suddenly the sugar breaks through and they're binging again they're eating sugar again. And so, what's challenging is that the medications don't always hold, and this means that it's not a sort of lasting, permanent, effective solution for a lot of people. People are going to typically find that they need additional support other than the medication. Emotions can break through. Then finally, what I'm hearing from people who've been on the medications for three or four or five years, and we have people who were on them for diabetes a lot longer than that, but even in a weight-loss context, we have people who've been on them for three or four or five years and I'm not sure about the exact dates of like when did they get approved for weight loss, but people were using them off label for weight-loss even before that. Doctors knew that these drugs caused weight loss a long time ago. What I'm hearing is the drugs worked better at the beginning. There was a honeymoon period for the first year or two and then after that in terms of sugar addiction, they don't work as well.
Now the final asterisk is I'm curious about something. We don't have data on this yet, but I'm super curious. If someone doesn't do something to restore their baseline dopamine firing to correct the dopamine downregulation before trying a weight loss drug, are they at greater risk for anhedonia? Here's what the research shows on these drugs in terms of mood. On average, across large swaths of the population, the weight-loss drugs actually improve mood. They make people happier and they make people less depressed. Massive clinical trial just came out on that. Huge numbers of people. That's robust. However, there's a subset of the population that's reporting anhedonia. What is that? It's bleakness, listlessness like nothing feels good anymore. Nothing feels exciting. Nothing feels pleasurable. Now, my neuroscientist's brain is going, "Uh, I wonder if those are the people who started on the medication with an untreated addiction to begin with, with dopamine down regulation, without enough baseline dopamine firing, then got on the drug. The drug takes away the spikes, the drug takes away the hit, the drug takes away the addictive compulsion but leaves the person feeling bleak all the time because there wasn't enough baseline dopamine for everyday use." So, before you go trying a weight-loss drug to treat sugar addiction, I encourage you to do something like Bright Line Eating® to try healing your dopamine receptors at baseline. You might find that you don't need a weight-loss drug after that because Bright Line Eating has been clinically shown to produce the same results, the same weight-loss results, the same reduction in food noise, pretty much the same results across the board.
Here's a graph right here and these long-term data were published in "Frontiers in Psychiatry," the second to top journal in that field, on our six year follow-up data. But check out these results. If you look at the semaglutide here is Ozempic, that's Wegovy, that's one of the most common weight-loss drugs today and Bright Line Eating goes toe to toe with it, including better results at the four- to six-year mark in terms of weight loss than weight-loss drugs. So, What I'm going to do is I'm going to put a link to our 14-Day challenge. Bright Line Eating is full on. It's not for the faint of heart, but it's also amazing how easily you adapt to our schedule and our structure of eating once you get used to it. We do have data showing that hunger and cravings, the hallmarks of that dopamine downregulation, especially the cravings, restore after just eight weeks on our program. So, try it for 14 days, see if it's something that you might like. We live in an interesting age where the landscape on weight loss and addiction is shifting daily, and just happy to share the science with you as I understand it. That's the weekly vlog. I'll see you next week.
