 So I'd like to talk to you today about a small piece of a very big puzzle, which is obesity and addiction. And I think that by understanding how your limbic brain works, that's your paleo-brain, your paleo mammalian brain, you can actually retrain the brain to effectively combat some of the things that undermine attempts to overcome obesity and addiction. So, as Tyler mentioned, I write the blog Getting Stronger. I'm applying the concept of hormesis or low-dose stress, beneficial stress, to deal with a whole range of different health issues. So, you know, I've talked about myopia reduction and the benefits of living at high altitude, some of the issues with nutritional supplements, and just generally about hormesis. And a disclaimer, I'm not an expert on addiction. You know, I don't counsel addiction patients or former addicts. I'm not an expert on obesity. Other than having some good experience with losing weight myself, you know, that's not my field. I'm really looking at the research and seeing what it can tell us. So as a caveat, you'll see some interesting ideas that may be controversial here, but consult with your own professional before trying to do anything extreme. So here's the three key questions I'd like to talk about today. First of all, these epidemics that we're seeing of obesity and addiction, you know, are they the inevitable result of the supernormal stimuli that we see around us, you know, the tasty food, stronger drugs, or is something else going on? And then what are the psychological and brain processes that drive our cravings for food, drugs, and addictive behavior? And how can we actually retrain our brains once we understand that to make us less susceptible to those cravings, which often undermine diets and attempts to overcome addictions? So I think we can't deny, these are huge issues. More than a third of Americans are now clinically obese, and you can see that regionally this is a big problem, particularly in the Southwest and Midwest, but it's even elsewhere in the country. And the CDC is tracking even, you know, addiction, a similar wave of epidemics going on, particularly the opioid epidemic, which we hear in the news every day, but not just synthetic opioids, you know, heroin, other drugs that are opioids, are having very strong negative effects and even a lot of overdosing. So it's a serious issue. But it's not just food and chemicals that lead to addictions, right? It's activities. It's gambling, smartphones even now. Shopping is an addiction, apparently. Social media, pornography, the Internet. And so it's got to be more than just chemicals that are driving addictions. What is it? If you look at both, you put addiction and obesity side by side, they're multifactorial. And I'm not possibly going to be able to talk about all of the causal inputs to these two issues. I mean, if you look at obesity, there's dietary factors, inflammation, the microbiome we've been hearing about, exercise, addiction. There's a lot of developmental issues with the stage at which you start using drugs, your risk profile, your mindset. But then there's some common elements to both. The genetics, depression, anxiety, your social status, stress, these all contribute to both problems. But what I'd like to do today is just pick out one factor in this entire causal network, cravings. Why? Because you can have the best diet in the world or a very good addiction coach who's going to help you with treatment. And if you have cravings that are irresistible, all bets are off. So how can we deal with cravings? Let's go back to this question of supernormal stimuli. I can recommend two good books, one by Deirdre Barrett from Harvard, on the classical, biological evolutionary reasons for supernormal stimuli. The classic concept here comes from Tim Berrigan who studied how cuckoos can trick other birds to watch the eggs in their nests by laying very similar, often more attractive eggs. And here you can probably guess which of the blue eggs the cuckoos snuck into the nest. It's the one in the upper right. And then Stefan Guyané, who's familiar to all of us here at AHS, has written an outstanding book, The Hungry Brain, where he goes into the brain processes, but not just the brain processes, the social phenomena that lead to these supernormal stimuli targeting different reward circuitry. And you can see here that now, just like the cuckoo makes a brighter egg, we make bright shiny donuts that trick us into eating more calories. But is this an inevitable process? Do food and drugs really just hijack our brains? Or is it something a little bit more subtle? Is it a behavioral conditioning process? I mean, only a small percentage of people who consume alcohol or stimulants, or even opioids, for example, in hospitals for brief stays, only a small percentage actually turn into addicts. And eating tasty food by itself doesn't automatically lead to a food addiction or overeating. I mean, obviously genetics in your social environment and stress play a large role, so it's not just the chemistry itself. And I think a key point here, stimuli are not inherently addictive. In fact, the desire for even Coca-Cola varies globally. And Seth Roberts, who some of you are familiar with, he cites the case of this Japanese cookbook author, Gaku Homa, who described his first taste of Coca-Cola as like medicine. So we have to learn flavors. We have to learn pleasures. So let's suppose you're in this world and you're overwhelmed with supernormal stimuli and you're finding yourself to have an addiction or a craving. Should you just abstain? Well, you know, this might work. And 12-step programs can be effective for some individuals, right? You basically, once an alcoholic, always an alcoholic, right? Stay away from the stuff. And similarly, there's 12-step programs for smoking and sex and pornography and kleptomania, gambling, and even workaholism. But it's not successful for everyone. I mean, even AA finds that after 10 years, only a third of their, from their own internal surveys, remain sober. And some don't even, another third can't even make it for a year. There's a high dropout rate. And independent studies of these kind of abstinence processes show that the true long-term success might be something on the order of 5% to 10%. So I'm not trying to diss these programs. I'm just saying it may not be enough. And also on the food side, can we just eat less palatable food? I mean, Stefan, on his blog, was talking about how some of our ancestral tribes ate far less palatable food. And so they weren't driven to eat all these calories. So he came up with this idea of the bland food cookbook. And one of the recipes might be a baked potato. But if you look more closely, I mean, Stefan is not, he's got a sense of humor, and he wrote this post on April 1st. But he was trying to get a certain point across here. All right. So what's the other model then of addiction? I'm going to dig into two books, recent books, both by former addicts. So even I can't speak from the experience of addiction. Here's two people who I think have some authority. And Maya Salovitz has written this great book, Unbroken Brain. She was an addict. She tried just about every drug in the book and worked her way out of it. And her view is that drugs are not inherently addictive. They only become that way if people learn over time to associate them with pleasure or relief. So she's postulating that we should think of addiction as a learning disorder. And she writes a lot now on addiction. She's got this New York Times bestseller and speaks a lot. So let's look then at what are the processes that are going on here? Well, addictive brain processes are coded in our paleo mammalian brain. And there's really two parts I'll focus on here and reflect on here. One is the limbic system, which we'll get into. It's the hypothalamus, the amygdala, the hippocampus, and maybe it's other pieces. And then there's some reward circuits in the basal ganglia, the ventral striatum, the VTA, and the nucleus accumbens. This is kind of the pleasure center. And these work together to reinforce our reactions to stimuli and even lead to, they can explain a lot about addiction. So I think it's most useful to look at two separate kinds of processes involved in addiction. One is a very general process, a hedonic process that modulates homeostatically your just general level of pleasure in life. And I'll get into the opponent process theory and this concept of allostasis, and how these modulate the hypothalamus and your receptors by down-regulating them in addiction. The other is a set of very specific reinforcement processes, and here the model is pavlovian or classical conditioning. And this is where your amygdala and some of these dopamine-based reward circuits play in. So let's start with the general process for homeostatic control of pleasure and pain. A great set of papers by Solomon and his graduate student Corbett who looked at these paradoxes. They were trying to explain what they called hedonic reversal. And in one case, how is it that you started out taking something that's very pleasurable? You know, drug, alcohol, sex, food. But over time it becomes less satisfactory and you even start to fall into a state of despair and depression. And life is just not fun anymore. And on the other hand, how is it that people who expose themselves to stressful pleasures like skydiving, or firefighting, or marathon running, or my favorite cold showers, how is it that even though after they make it through that experience, they actually experience pleasure? So here's a classic case study that Solomon and Corbett were looking at. Skydivers. And I'll just read you the physiology of this because you kind of get the idea of this hedonic reversal process. So during the first free fall, a novice parachuter, before it opens, the parachutists may experience terror. They may yell, their pupils are dilated, their eyes are bulging, their bodies are curled forward and stiff. Heart is racing. After they land safely, they may walk around with a stunned expression for a few minutes and then they smile and chatter and they're socially active and they appear to be elated. Now here's the key after repeating this multiple times. The signs of effective habituation are clear. The fearful reaction is usually undetectable or very short. The parachutists look tense and during the free fall, they experience a thrill. The activity level is high with leaping and shouting and euphoria and the period extends to as much as two to three hours. So you can see the process has changed. So here's the model and this works for both addiction when you're looking at the pleasure turning into pain and skydiving when you're looking at pain turning into pleasure. So take a look at these plots here and you'll see what's called the neutral line. That's the zero going through these plots. That's where you start out. You first expose yourself, let's now take to a drug, alcohol, cocaine, whatever. You get this positive state called the A process where it's pleasant. Now here's the key. Your brain doesn't want too much pleasure or too much pain, so it immediately kicks in a counter process, an inhibitory process to kind of keep you within a range. Too much pleasure, not good, so we'll now start adding a little bit of down-regulation of those receptors and now that initial high starts to flatten out and you can see in that first plot on the left, that's the adaptation. Now the experience is over, you actually go into a somewhat of a down where you're feeling less happy than you were to start with and it takes a while to recover. If you look at the plot on the right side, this is after many, many repetitions, you can see that pleasurable state is getting weaker. You take the drug or whatever and it's just not as pleasurable as the first time, so you have to increase the dose. And the problem is now after you've used the drug, your B process is now strengthened because it's trying to combat the A process and you feel lousy and even for longer periods of time. So it's this process with repetition that gets you into the addictive cycle and I think also can get you out of it if you replace the initial painful or a pleasurable process with a painful or uncomfortable process. So how does this work in the brain? It's again in the hypothalamus. The hypothalamus I have here, you can see a set of little dials. It basically keeps track of where you are in terms of too much or too little, your body temperature, your heart rate, your appetite, your thirst, mood, sleep, weight, cycle, sex drive, and even for certain periods of time it regulates childbirth. But it's blind to the world. It just gets input from external signals, from hormones, neurotransmitters. It tells it, you know, turn up the heat, turn down the heat. In the case of appetite, one part of the hypothalamus, the lipostat is composed of two sets of counter-regulatory receptors. The lateral hypothalamus has some neurons in it that work to increase appetite and slow fat burning when stimulated. And in the green, the ventromedial hypothalamus does the opposite. It suppresses appetite and it burns fat. And it's basically just taking signals, turning it up, turning it down. And this applies to all those other drives. So Judith Grisel, another great book, and I recommend this, called Never Enough, again a former addict, and took her experience and she actually tried to hack her addictions and studied neurobiology and actually now is a professor of psychology at Bucknell and an expert on addiction. And she kind of actually used this opponent process model to look at the A and B processes for different classes of drugs, so for stimulants. These stimulate the dopamine receptors. These are, you know, mild stimulants, caffeine and nicotine, but this could be as strong as cocaine and amphetamine. And you get this desire and energy level. It's called wanting process, right? And, but the B process kicks in when that disappears. And that's where craving, anxiety and boredom and tiredness kick in. Opioids and depressants, it's kind of a different process. You go immediately to this liking process by stimulating the different opioid receptors and serotonin to some extent and GABA and glutamate and ion channels. But then when that A process, that liking process is over, the B process kicks in and you feel irritable. You feel actually pain or suffering and anxiety and malaise. And so you're driven to do something about it. So Kent Barrage and Robinson and also Kub and Nora Volko who have written a lot on addiction have put this into this model, kind of the incentive salience model of addiction. And if you start over here on the very bottom, the anticipation, you know, you're looking for something, you're excited, you're, you're, this is called the pleasure of the hunt, you're hunting for something here. And there's a certain pleasure associated with that. So now you binge, you drink a lot, you smoke a lot, whatever it is, you engage in some activity. And now you're in the liking phase, everything is good, the world is fine, your opioids are stimulated, this is the pleasures of the feast. You know, you've eaten a big meal, you know, you're feeling great after the alcohol. But then you go through this kind of withdrawal, the B process kicks in, you're frustrated, there's less reward, increased stress. And so this leads to the other renewal of anticipation. Now you're out there looking for more pleasure. And again, you go through this multiple times and this is really cool. George Kub extended this opponent process theory of Solomon and said, you know, you don't just always come back to the same baseline. Every time you exceed these homeostatic thresholds, the A process gets too much and the B process comes down. Each time you do this, your baseline goes down and down and down. And I love this diagram that shows sort of the spiraling down into discontent. And at the end of it, the addicts, they actually are taking the drug just to get rid of the, just to get relief. And they don't necessarily even feel good. And you know, if you play with your smartphone a lot, you start playing with it, you play a game and you're like, you know, this is a waste of time, but you're driven to do it. You've got this drive to do something and you don't even feel good in the satisfaction phase. So if you look at this at the level of receptors, you can see it too. I have a just kind of hypothesis, I call it the receptor control theory and that is the more and more sensitive receptors you have of any kind, the better off you are. So we know this with, for example, insulin and leptin receptors. If they're more sensitive, insulin sensitivity, leptin sensitivity, you can control your diet. But I think the same thing is true of dopamine and if you have, if you look at the guy on the far left here who has only a few receptors of whatever kind, he's unhappy. If you move to the middle to the right guy, the one with a lot of these receptors, he's basically doesn't need much of any stimulus and whatever stimulates his receptors, whether they be dieterally or pleasure, he's happy. And so I would say obesity and addiction can be thought of as dopamine resistance. You're just overstimulating these receptors, they shut down and now you need more. And you can actually see this. Nora Volko has done PET scans looking at the brains of cocaine addicts, meth addicts, alcohol addicts, heroin addicts. You can see versus the control, this is looking at the activity of the dopamine receptor, using an imaging study on the PET scan, you can see that there's, red is good, red means there's a lot of receptor activity. You can see that the addicted equivalent for every control here, the red is missing. And similarly for obese subjects you can see that the control subjects had a lot more red, had more dopamine receptor activity than the obese subjects. It gets worse with time. Here's a study by Witton showing that after six months and after 12 months the activation of the receptors is going down if you're using cocaine. And don't think it's just substances, smartphones. I mean the average American is looking at their smartphone for two to four hours a day, you're 2,600 touches, all those dopamine cycles, there's even something here called phantom phone sensation. I don't know if you've ever experienced this where you think you're feeling your phone vibrate in your pocket, or you think you're hearing it ring, but it's not, your brain is just primed there. How do you reverse this? It's my standard answer, hormesis. If you look at calorie restricted mice, whether they start out obese or lean over, they're calorie restricted for four months, look at the top, which is unrestricted food axis, and then look at the two scans at the bottom, much more dopamine means receptor activity. So they don't need as much dopamine to feel happy. Similarly in humans exercise, there's a study of exercise for meth addicts, and the study was done by Robertson and found that the D2 and D3 dopamine receptors were significantly up-regulated, providing a protective effect for these addicts. So now let's get into the specific processes. This is about up-regulating or down-regulating your general hedonic level. And if you start out with feeling good generally and you're not miserable, you're going to have a better chance, but you still have to deal with the specific cues that we respond to all around us that trigger cravings. So classical conditioning is really a process that goes on all the time whether it's in the lab or outside, and basically it's stimulus response behavior, it's response to specific cues, and these are created by the amygdala and the reward circuits, and these can be conditioned for good or for bad. So there's a number of even deconditioning strategies, but let's talk about what conditioning is. First, the kind that most people are familiar with is called operant conditioning, and this is from Skinner, and it's the classic case of how you train your dog, right? The dog catches the ball and you signal that maybe with a clicker. And at first there's no cue, but now you ring the bell or blow a whistle, and if he doesn't catch it, you don't reward it, but if he does catch it, you reward it and you're reinforcing that behavior. Pavlov, you know, I think looked at a different phenomenon which is just involuntary physiological responses, which can also be trained. And I think you can think of these as a specific special case of operant conditioning. You're training a involuntary response, not a voluntary behavior. So you have this unconditioned stimulus, UCS, piece of meat the dog naturally salivates and you reinforce it when you give it the meat. Now you ring a bell, which doesn't know anything about that, it's called a neutral stimulus, there's no response. But what Pavlov found is if you rang the bell at the same time the dog saw the meat, the dog started to associate the bell with the meat and it would salivate, and now he could just ring the bell without the meat there and that's called the condition stimulus and the condition response and now the dog is conditioned to just the cue. So just like you walk into the bakery and you see the pastry there, you didn't eat it, but all of a sudden you're feeling hungry. So let's contrast the hypothalamus and the amygdala here. The hypothalamus, it doesn't know what's going on, it's just either hungry but it doesn't know what to eat. The amygdala says, I want that specific piece of dark chocolate that I'm conditioned to, I won't take milk chocolate, only dark chocolate will do. The hypothalamus has a sex drive, hey, gotta have sex but if there's no tall, dark men around, no facial hair, no good sense of humor, maybe even not the husband, all bets are off. The hypothalamus wants to go to sleep, right? It's regulating sleep but the amygdala hears a suspicious noise outside and they can't get to sleep. So all this information is now modulating the hypothalamic response. So you can think of the amygdala and its helper which is the hippocampus which basically is storing memories it's storing all those conditioned associations. The amygdala it immediately gets gut reactions. It sees a barking dog immediate fear. You see the ice cream, I want it. You're not even going through any cognitive process here. You're training these gut reactions and similarly there are these reward circuits in the basal ganglia that reinforce the wanting cycle and this is again from Barrage and Robertson. You can see there's the wanting cycle which everybody pays attention to. That's the dopamine circuit there on the right. But then, and that's going to the nucleus accumbens. But then there's also an opioid, sort of a liking cycle that's going to different parts of the brain and these are trading off. So you got to take the different circuits into account that work in tandem with the amygdala. Now there's also one more element I'd like to go into before getting into the solutions here and that is timing. So there's another hormone called grailin that the stomach produces when you're hungry and tells you it's time to eat. What's interesting is again that's conditioned. You think you're hungry at noon but that's just because you're used to eating at noon. So here's a study of actually some humans that were put on different meal frequency programs either eating lunch three hours after breakfast or six hours after breakfast. And they did this for two months. And what's interesting here is if you look at the grailin plots, they tracked with hunger. The grailin is the black circles and the hunger is the white circles. And eventually the grailin secretions and the appetite adjusted to the meal frequency. And this is why intermittent fasting can work. You think you can't wait until dinner? Once you do it enough, you're no longer hungry until dinner. So let's go into the strategies that you can use here. How do you actually stop on one of your Q responses? Well, the first is stimulus avoidance. That's the AA process, abstain. It's great as long as there's no Qs around but it doesn't actually rewire your brain to respond differently. There's Q exposure and extinction processes which I'd like to talk about. And that's where you expose yourself to the stimulus but you don't let yourself respond. And then there's counter conditioning where you substitute an alternate response when you see the Q. And then there's one called putting on Q, which is you plan a particular time and place where you'll be allowed to have the Q. So Pavlov even showed this. And believe it enough Pavlov showed you could not only condition a bell, but you could decondition the dog's response to meat. So there really is no such thing as an unconditioned stimulus permanently. So he exposed the dog to meat time after time and eventually the dog stopped salivating. He says, I'm not going to get any meat. So why should I get hungry? And actually he measured salivation and the dog stopped salivating amazingly. So there's actually a therapy called Q exposure therapy and this is one that's interesting to study. I'm not necessarily recommending that you do this, but think about this as a model. And you retrain the responses by systematically exposing yourself to Q's. They could be sensory stimuli, objects, places and times, but don't let the response follow through. So a drug user might look at the paraphernalia, handle it but not take the drug. The alcoholic drive by the bar. Go into the bar, but don't consume. Pull the cigarette, but don't smoke it. It sounds painful and sounds awful, but it's amazing. It works. And Conklin and Tiffany did a study of 18 different trials. Now only nine of the 18, I'm sorry, only nine of the 18 had control groups and about half of them, those were successful. But the half that were successful were very successful and he found there were some key factors. You can't just do this a couple of times. You've got to do it repeatedly. You have to vary the context of the exposure. So in different settings, not in a lab setting, you can't just go look at a bottle of gin in a lab. You've got to actually handle it in a variety of situations and you've got to do it repeatedly and you'll even have to fold in some behavioral facts. But he found that in the studies where this was done, it was very effective and then the addicts lost their cravings. There's a variation of this process called Flavor Calorie Association Extinction and some of you are familiar with Seth Roberts who was a key speaker at many of the AHSs, one of the founders. His Shangri-La diet was also tested in one of the posters we saw here. The key thing here is what's unique here is you've got in food a cue and a reward all in one. It's not two separate things. So the food has the flavor which is the cue and it has the reward which is the calories. And what Seth found, both from his own experience and looking at experimentation and then writing a diet book on this is that if you separate the calories from the food, you can decondition those cravings. So for example, you can take flavorless calories like light olive oil or eating while pinching your nose because really flavor is mostly olfactory and then you break that association. Or you can just have the flavor without any calories or you can even eat foods with unfamiliar flavors because cue conditioning is only effective with familiar flavors. Now this might sound strange but I lost weight very easily following this diet and some people have lost over 100 pounds doing this. So there's something to it. It's a very strange but it's really an example of extinction. So let me give you a few examples of how you might apply this to different food or other addictions. So let's say you want to decrease your cravings for cinnamon buns. So the normal response would be eat the bun but what you do instead is you go into the bakery, you look at it, you smell it and you do this again and again. Sounds like torture. It actually works. I've done this myself. I've gone for those foods that I crave and I don't want to eat too much of and after a while you don't respond to that stimulus anymore. So the counter conditioning is to substitute another activity and this would be smell the bun, go for a walk. Similarly if your cue is the bar, the sign at the bar you'd normally crave a drink. So instead of stopping for a drink look at the sign and just call a friend. The key here with counter conditioning is to substitute an alternate pleasure. You see your smart phone, you're always I got to check it. I got to check it. We'll touch the phone. Don't put it away. But don't look at it and schedule a time window to look at it. So here's how you boil this down into some practical techniques. This is something I wrote about called the deconditioning diet. Your blog is in three phases. You reduce insulin and stabilize your blood levels, follow low carb diet, eat three meals kind of lower the general level of stimulation. You decondition by a couple of things. Don't eat right when you're hungry actually resist that. Wait until your hunger subsides and then eat so you're not reinforcing the cue and even more so expose yourself to the strong food cues, the aromas, the shapes and then substitute an alternate pleasure. Go into the bakery walk around, smell everything, now go for a walk and call a friend. And then the more you can do that you can embrace intermittent fasting because you're less consumed with cravings. You can reduce your meal frequency and continue the deconditioning process. So then the general approach then, how do I apply this just to addictions and cravings in general, I start by using physiological hormesis to increase my hedonic level. Instead of engaging in pleasures I engage in difficult activities like not necessarily skydiving but maybe going for a run, lifting weights trying cold showers, fasting. These are hard things but the more you do them you actually increase your number of dopamine receptors and you're more resistant. Now decondition the specific cravings. It doesn't have to be food this time. It could be some drug cue, it could be a gambling cue, whatever. Expose yourself to the stimulus but don't allow the response to happen and substitute something else. Now the key thing here is plan it out so you have those alternate activities planned. And then rebalance your life, rebalance pleasure. Don't necessarily eliminate all pleasure. You can't do that but you now are in a position to decide what you're going to respond to and what not. You can pursue a healthy diet. You can either reduce or eliminate drugs. So I've got here and you can check this out when the videos are on. Some further reading here, right? I also would encourage you, there's a number of articles on getting stronger.org that deal with these issues of the opponent process theory, addiction and eating and fasting. And my final summary, addiction and obesity are very complex. They're multifactorial. It's very challenging in both. The central challenge that defeats both are these overcoming irresistible cravings. Supernormal stimuli around us but they're not inherently addictive. They're only so because they're conditioned to be so. So we can get our way out of it by two processes. One, general hedonic reversal and receptor down regulation. We can use physical challenge to work our way out. Hormetic exercise, fasting and cold showers and we can recondition those responses to specific cues by cue exposure and counter conditioning. So again, my goal here was to put some ideas out, not to give individual medical advice. So seek assistance if you're dealing with a very difficult addiction. But if it's something pretty light like smartphone addiction or you're eating a little bit too much, you might try this. So that's my talk. Any questions? So we've got about ten minutes for questions and then the good news is there's nobody in here for an hour or so as long as you can corner Todd and keep him away from food or drink, you will be able to keep him here for questions. Hey Todd, thanks for sharing all that. It was interesting and also validating as a health coach who's still pretty new. I use almost every technique you have in there even though I don't have a food addiction history or anyone in my life like that. I wanted to ask you my point of view has been so far that people will come to me for help say they want to quit smoking or they want to lose weight and they swear that this is all that matters to them right now. They really want it but they can't make themselves do it. So say they have the perfect information that has the potential to change that particular person's life but what is the psychological barrier or that point at which it becomes the right moment. That's a good point and there's many other aspects to counseling, right? This deconditioning process is a small piece. There may be depression, there may be trauma, there's a lot of other things going on so I'm not going to deal with that. But what I would maybe start with is ask them to make a log before they start any process. Have them observe their own behavior and figure out what are their cues. What is it that immediately proceeds reaching for the glass of wine or lighting up or engaging in pornography on the internet? What immediately proceeds that? What time of day? So start by observation and then you can maybe develop a plan for counter conditioning and extinction. I guess to further explain what I'm asking is what about when they almost ignore it, like they shut down, they rebel, like they're like I don't care anymore. Like what is going on there exactly I know you can't say exactly. There's a motivation issue. I think I'll make the assumption here that the person is motivated. That's step one. If they're not motivated, this won't help. But there's a lot of people who are motivated and this is what trips them up. It's the cravings and they know they should be eating low carb and they know they should be avoiding it and they're motivated but they can't overcome the craving. So I can't deal with those who are not motivated. That's a different talk Okay, interesting. Thank you. So my question is related to neuroplasticity. I'm really tapping into the work of Dr. Joe Dispinza and Dr. Bruce Lipton on the idea that neurons that fire together, wire together. And the idea that 95% of our thoughts and behaviors are controlled by the subconscious mind which we don't even, oftentimes we're not even aware of. So my question is what are your thoughts on using your suggestions also incorporating techniques like meditation and visualization and maybe certain forms of breath work that really help get our brains out of that high beta state into that alpha state where we can really start to tune into our subconscious mind and change those beliefs? I think those are great ideas. I see this as a complementary set of tools. It's just one to add to that. But on your point about neuroplasticity and the automaticity of this behavior, I also think cognitive behavioral therapy is great. But thoughts are these conscious thoughts. This is not CBT. This is going to a very basic level of just pure behavioral conditioning. It's going after those automatic responses. But you can use this in tandem with CBT in tandem with mindfulness and other techniques. Thank you. Fascinating talk. I wish I had gotten here at the very beginning. Thank you so much. Near the end when you were talking about dopamine response, dopamine receptor sensitivity which is something that I understand decreases with time. And you mentioned hormetic stressors that would restore that dopamine receptor sensitivity. Is that always the case that you use a hormetic stressor to restore that or is it context specific? For instance, if I get a spurt of dopamine from both entering giveaways on Instagram and pressing myself to do a hit workout that is not, probably not pleasurable in the middle of it, but you know at the end there's the sort of endorphin response. But it's a hormetic stressor. Where is the Instagram giveaway? That's easy. Exactly. Are these both restoring the, or are these affecting the dopamine receptor sensitivity in different ways because the other is more difficult? Yes, the difficult one is helping to upregulate the dopamine receptors. You're still getting dopamine in both cases, right? That's the signal. So I'm focusing not on the signal but on the receptor which is really a key difference that people sometimes ignore. And this goes back to the opponent process. When you're engaging in these difficult activities, that's your A process, you're now, the response is going to actually make you more sensitive to dopamine and it won't take as much the next time. Can I pose an alternate situation which you're doing the hit workout but you're getting, you're doing it because you get a dopamine response from it. So it's both during and after word and you engage in it because it's an addiction. I hear you and one question people have asked is what about running as an addiction or what about sports as an addiction? Yeah, there's good addictions and there's bad addictions in the way I would say addictions aren't necessarily bad, right? Addictions are bad. Going back to this learning theory is if they interfere with your life, if they interfere with your coping, if they interfere with your health, but if they're not interfering, if they're actually improving your life and if your happiness is going up, fine, reinforce those good things. I'm just looking at the case where you pursue pleasure and get kicked in the butt because that doesn't work. But it's, but you're directly pursuing pleasure where when you're doing the hit workout, you're first exposing yourself to a stressor to get a subsequent pleasure. It makes a big difference. But the tolerance over time where you need to increase the time or the intensity and with diminishing response, diminishing dopamine response, that's where you might run into problems. Possibly, but that's not what Solomon and Corbett found. They found that the skydivers actually needed, their fear level went down and their pleasure went up over time. That's the whole paradox here that's so wonderful if we can exploit it. Thank you. Clearly pleasure is not the problem, right? Thanks so much. I really enjoyed that. I wanted to ask you about carbohydrates because I noticed at the beginning of your protocol, the first thing you do is try to get people to stabilize their blood, sugar and take, I guess inadvertently also maybe taking out some of those real trigger foods that are very much at the center of food addictions. And we know that both fat and carbohydrates stimulate a dopamine response and that when you eat them together, that dopamine response is summed. Do you think that the power for a ketogenic protocol to undo the attachment to those kinds of highly rewarding foods is just sustainable over a long term? Will somebody on a ketogenic diet also then develop a hedonic response to high fat foods over time? No, that's a good question. I don't necessarily know the answer, but to follow on there, I found that it was very easy to start a ketogenic diet in the beginning, but after a while it's hard to stick with it because it's boring or there's not enough pleasure from it and you're still now tempted by other foods. That's where I think some of these conditioning strategies might help to get you through that phase. But it's a really good question. I couldn't answer it specifically with the ketogenic diet. Well, Todd, that was a pleasurable talk. I liked it a lot. Now you're not going to like it tomorrow. Ten minutes from now I'm going to be wanting more. But actually I came up here with a serious comment because it came up about the role of other approaches like cognitive behavior therapy that can possibly in tandem with these conditioning level types of mechanism. And it turns out one of my colleagues at UCLA, Michelle Kraske, a professor of clinical psychology, that's what her lab has actually been looking at. She's done a lot of work and they treat in her lab anxiety largely as a main focus and PTSD and developing treatments and understanding the science of it. But one of the things they've been turning to over the past five years or so is they for a long time have been applying conditioning and that knowledge to studying it in clinical patients. They've been now turning to that in conjunction with mindfulness or with cognitive approaches, ideation, things like that to see if you get more efficacious treatments when you combine them. I think that's a great concept because by stilling the mind and quieting it, making it more receptive to inputs, you might get a more effective conditioning or reconditioning process because you're not distracted by so many stimuli, you're focusing on just the ones that are involved. But you first got to achieve that mindfulness state and lower that. I'd like to see how that works. I think it would add to what you're talking about, which is great. So you were talking about walking in and getting the stimulus of the Cinnabon factory and then not eating it going for a walk, calling a friend. So adding that pleasurable substitute that pleasurable thing in place of eating the Cinnabon. What if you walked into the Cinnabon factory but before you went on the walk and called someone, you added a negative or an unpleasurable thing like a doctor or just something negative, a little prick of a pin or just something really minor negative. Does that enhance or speed up the process? That might work. From what I've read, aversive conditioning is far less effective than positive reinforcement. There's a great book if you want to train an animal or train yourself and it's in the syllabus there that my reference is called Don't Shoot the Dog by Karen Pryor. It's wonderful and it's about why negative reinforcement or actually why punishment doesn't work. Negative reinforcement is just not is a different thing than punishment but of all the conditioning positive reinforcement works far better and especially when it's reinforced immediately at the very same time without a delay and strongly. She trains dolphins and she can get them to do anything with positive reinforcement and it doesn't work with punishment. So you can try it but it often tends to condition a alternate behavior to avoid the whole situation and it doesn't really deal with the actual pavilion conditioning. Thank you. I seem to recall that in my admittedly limited research on the subject intermittent positive reinforcement often works better than completely consistent positive reinforcement e.g. if you're absolutely correct in that receiving the roar right away so that it's powerfully associated is extremely important but in a lot of research I remember if that doesn't always happen it actually ends up being a more powerful conditioning stimulus than simply rewarding every single time. You're exactly right in fact Skinner found that out by surprise and then he used it to explain gambling behavior. If you hit the jackpot every time you're not nearly as reinforced as if you get it sometimes and then it might happen tomorrow it might happen again so intermittent reinforcement far more powerful which is why with clicker training in that slide I showed with the dog after the first couple of times you can just click and the dog goes oh that means I might get the meat and it's actually very powerful so that's a really good point thanks for bringing it up Jay. Well I guess that's it. So go out and try this extinction process or counter conditioning and I'd love to hear from you as to whether it works for me it's amazing how quickly it works in a matter of days. It's unbelievable that the hypothalamus is smarter than you are. So take care.