Hey there. It's Dr. Susan Peirce Thompson and I've been writing on Substack lately and I just published an article about expectation driven dopamine, and it has everything to do with Bright Line Eating®. I thought I would talk about it with you here.
What is expectation driven dopamine release? Well, let me back up and just say it helps explain something that's been a puzzle for me for decades working with people in food addiction recovery. It's the colonoscopy question, which is why don't people get triggered by the sugar in the colonoscopy prep? I went online and started looking it up and the colonoscopy prep that they were prescribing for people when I was working with a lot of people one-on-one, this would've been 10, 20 years ago, it had the equivalent of the same amount of sugar as three cans of Coca-Cola. People would have to drink it over a two hour period and it would clean out their system. I mean, a lot of sugar. I worked with so many dozens, maybe hundreds of people during a span of years and watched none of them ever, no exceptions, ever get triggered by the colonoscopy prep. That amount of sugar being led into their system from any other means would have triggered them, I'm sure, to want to eat more sugar afterwards. And it didn't. And I could never figure that out.
I always said, and I still stand by this and it's what this vlog is about, that drugs hit you differently when you're taking them as medicine. Motives matter. So, if you are intending to use when you ingest something, it's going to hit your brain differently. But I never looked into exactly why that works that way or what the neuroscience is underneath it. I just noticed other situations where it was in play. For example, there was a time a bunch of years ago where I was in relapse with my food. And as I do when I'm in relapse, I made myself some raw cookie dough in my own kitchen. I made it by hand, and I was in a super frantic state because I needed my drug, I needed my fix and I couldn't wait to get that sugar into my system. As part of it, I poured vanilla extract into the bowl free hand and was pretty heavy handed with it because I like the taste of vanilla. I stirred it all up and I ate the raw cookie dough. Then I went, "Oh no, did I just break my sobriety?" I probably had, I don't know, 20, 25 years of back-to-back alcohol-based sobriety at that point. I wasn't intending to use alcohol. I was intending to use sugar as a drug for sure, but I wasn't intending to use the alcohol. But I felt a little tipsy. I felt the alcohol hit me. And I went, "Oh my gosh, there was alcohol in that." I didn't go back for more alcohol or vanilla extract. To the contrary, I wanted to clean out my system. I just felt sick to my stomach that I had consumed alcohol. I didn't mean to consume alcohol. I did not consider that a break in my sobriety because I was not intending to drink alcohol.
There are other situations where people do drink alcohol, but I wouldn't consider it a break in their sobriety. So, for example, if you're at a party and you think you're drinking your drink and you take a swig of it, you had water, but someone's got a cup of vodka sitting right next to it, you may not notice till you've had a sip that, oh my gosh, that's not my water. That's their vodka. I wouldn't consider that a break in sobriety because you weren't intending to drink. What I'm talking about here today is that it's going to hit your brain differently because you weren't intending to drink.
The third and final example, and this is one I've dealt with over the years many times after surgery, the Vicodin prescription or Percodan or Percocet or whatever they prescribe you, but it's an opiate. It's basically heroin. It's some derivative of a narcotic opiate pain reliever. I've had a couple of C-sections. I had an ankle surgery. I've had a bunch of surgeries in my sobriety. And that Vicodin prescription's always a puzzler like, hmm, what am I going to do here? Well, I take the Vicodin as prescribed. I take it minimally and I take it as medicine and I take it just however much I need to make the pain not overtake me. It's kind of stunned me over the years how much I don't enjoy it. Again, motives matter.
What's the science of this? Well, first of all, in 2001, a Science paper was published. Now, Science is right up there with Nature as the top, those are the top two journals in the whole world, across all fields of science. Those are the top two, Science and Nature. And this was a Science article, which means groundbreaking, utterly earth shattering groundbreaking. You have to be in order to get into Science. So, that's what it was. It was a study that showed that if you tell people that they're about to get a drug and you give them a pill that's a placebo, the brain releases the dopamine as if they were getting a drug if you tell them it's a drug. This is expectation driven dopamine release. That's what it's called. Dopamine. All based on your expectations. So, there was that study. Okay.
Now, the other two lines of research I want to talk to you about are something called incentive salience. Incentive salience is a spotlight that happens in the mind that shines on the thing we want based on the cues that predict the reward we're about to get. Picture me in that kitchen about to get my cookie dough fix. The cues are the big silver bowl that I get out. Maybe if I use a hand mixer, the hand mixer that I get out, if that's what I always use to make my cookie dough. The two sticks of butter that come out, etc. Each of those things is a cue. It's a drug cue for me. And as these things are being assembled in the kitchen, massive waves of incentive salience dopamine spikes are happening in my brain in advance. I haven't even eaten anything yet. And it's flooding into my brain in advance. It's also narrowing my focus like a spotlight on these cues. Suddenly the kids that need me in the downstairs, I can't hear them. And the work I still need to do on my desk, I can't think about that. Nothing matters except this fix that I'm about to get. My mind zeroes in on it. It's called the incentive salience spotlight. It's a super powerful thing. And for addicts, it starts to tilt the tables of what even the brain can process in terms of consequences, in terms of circumstances. The brain stops caring what's going on around it. It just starts to fixate on these cues that are building up toward the reward that's coming and dopamine spikes are happening all through the brain. Well, not all through the brain, in the nucleus accumbens sort of reward, mesolimbic reward pathway area of the brain. Okay? So, there's that.
Now, that's happening in the mind. At the same time in the body, there's something called the cephalic phase response. The cephalic phase response is the body's homeostasis adjusting itself to brace for the drug that's coming, which is usually a toxin. Let's picture a heroin addict going to get their fix. What are the cues that might predict that? Well, the cash in their hand. They've now got a $20 bill, a $40 bill, or two $20 bills, whatever. They've got money in their hand. They drive to their drug dealer's house. Now, there's the neighborhood cue. They ring that doorbell, that's a cue walking up the path and ringing that doorbell, that's a cue right there. Then there's the needle, the spoon, these sorts of cues. All of these cues are going to be triggering incentive salience dopamine, but they're also triggering the body to brace for the heroin. Heroin's a sedative, right? It lowers heart rate, lowers blood pressure. Well, what's the body doing right as the fix is about to come in? It's raising heart rate. It's raising blood pressure to brace itself for the heroin that's about to be delivered. Now, this has huge consequences for overdose because if you use in your typical environment, all those cues are familiar and the body has a lot of time to brace. That means you can work up to a much larger dose and survive it without an overdose. That same dose taken, maybe someone injects you with it while you're sleeping. I don't know why they would do that, but if they did, or taken in a different circumstance, a new place with no familiar cues. Or I mean, I don't know, you're at a party and you just stumble on some people and they're like, "Hey, we're shooting up. Can I shoot you up?" And boom, it's done. And you don't have hardly any of the buildup or the familiar cues that you used to have. This is actually one of the most common causes of heroin overdose and other drugs too, overdose, is using your same familiar dose in a different context. That cephalic phase response can't kick in, sadly. So, it was interesting to dive into the details, the nitty gritty of the neuroscience of how the brain is actually processing your motives and the expectation of a hit.
Now, you're probably not a heroin addict. You might be, but you're probably not, statistically speaking. The odds are better that you do Bright Line Eating or you have some sort of food or eating struggles or issues that maybe you eat too much sugar, or maybe you have stopped eating sugar and you're on a Bright Line Eating food plan. How does this apply to you? Well, the bottom line is if you think you're using, if you think you're getting a hit, that matters because that expectation is going to release dopamine as if you're using. How could that happen? Well, let's imagine that you do Bright Line Eating and steak is on your food plan and you happen to have a particular love of a good marbled ribeye steak. And there happens to be a restaurant nearby that has an especially fatty marbled ribeye. And you have come to really love it. And you look forward to eating out there on Friday nights with your partner every week. As a matter of fact, you think about it multiple times all through the week. You cannot wait to taste that steak. In Bright Line Eating terms, we would call this food lighting you up. It lights up your brain. And now, we have the language for the science behind it of that incentive salience of the cues that are proceeding eating that steak and that expectation driven dopamine release is going to result in that steak, even though it's not sugar or flour, acting like a drug in your brain. This is why we talk about letting go, maybe forever, but maybe just one day at a time for a little bit, maybe just for a few months, letting go of foods that are Bright, but they're lighting you up. Because if your brain thinks that it's getting a hit, if your brain is looking forward to it that intensely, there's all kinds of related structural phenomena that are altering the way that food impacts your brain. It starts to move into the category of using, not eating pretty quickly, pretty quickly. So, food for thought, as we say, expectation driven dopamine release, it is a thing. That's the weekly vlog. I will see you next week.
