Behavioral health as a level of regulation

Behavioral health as an underestimated level of regulation. Many drugs, supplements, and strategies now use endpoints in the form of their target efficacy, toxicity, and effect on certain markers. Often enough, these studies are conducted in short-term intervals and may ignore long-term effects. One such consequence is behavioral measurement. The economic sciences, and indeed biomedical researchers, have recently begun to pay more attention to how our behavior changes, how our choices and risk preferences change. After all, our choices are a much deeper topic than mere knowledge.

Many "experts" ignore behavioral patterns, giving advice like "depression? Smile more!", "lose weight? Just stop eating!", "not working out? Try harder." Makes sense? Makes sense! But such simplistic logic won't work in complex systems. After all, conscious reflection and understanding of one's problem does not always lead to a change in behavior. After all, the subcortical dopamine system, which is responsible for motivation and action, and the prefrontal cortex, which is responsible for conscious reflection, are often out of sync. This is easy to appreciate; the more you distinguish between "should," "want," and "useful," the deeper the neurobiological conflict.

So, what to do with the dopamine system? Of course, scientists are itching to get their hands on it, because there are tremendous prospects for influencing behavior. Let's look at two cases in which completely non-toxic substances are used with a "logical" primitive goal that does not take into account long-term changes in human behavior. One case is the attempt to block the pleasure of eating, smoking and drinking in order to reduce addiction. The second case is the use of sugar substitutes (non-toxic and seemingly safe) in order to "get more pleasure" without the side effects on the figure. A good idea? Indeed, at first, everything looks harmless on the outside: from a toxicological point of view, everything is safe. But from a behavioral point of view, it looks pretty miserable.

The attempt to block the pleasures failed quickly. So, in 2006, the company Sanofi-Aventis put on the market the drug rimonaband (aka Acomplia, Zimulti), which blocked cannabinoid receptors type 1 (CB1), reducing pleasure from food and, accordingly, the craving for overeating. In addition to overeating, the drug also reduced cravings for drugs, alcohol, and helped quit smoking. But already in 2008, the drug was withdrawn from the market because of the numerous side effects. The point is that cannabinoid receptors type 1 (CB1) are located in the limbic system and have a pronounced stimulatory effect on mesolimbic dopamine, especially in the adjoining nucleus, so the drug helped addicts fight cravings.

It turned out that by blocking the pleasure of eating, we suppress the production of dopamine. In addition, rimonaband increases the number of dopamine D2 receptors and decreases dopamine production, which means that we have a lot of hungry dopamine receptors in the brain.

So what does "eating without pleasure" look like? Psychiatric side effects caused by the drug included anxiety, depression, agitation, eating disorders, irritability, aggression and insomnia, and an increase in family violence. Suicidal ideation more than doubled, including in people they had never visited, and several study participants committed suicide. Additional side effects that were observed in data collection over the years in patients: depressed mood, major depression, dysthymia, and depressive symptoms. Moreover, side effects were observed more intensely and more frequently than stated by the manufacturer in their clinical studies.

Are the pills worth the trouble? According to the world association of dietitians weight of obese patients for a year of systematic use of the drug decreased by 5%, so do other "wonder pills": a year of taking orlistat weight loss of 2.9 kg, sibutramine - 4.7 kg. Oops, failure!

What about sweeteners? After my post about their harm, I started getting references from people who disagreed that from a research standpoint, sweeteners seem to be safe and their side effects are small. However, my references to studies that NWs increase the risks of diabetes and neurodegenerative diseases were ignored. Okay, that's not what we're talking about today, but the long-term effects of behavior modification.

It has long been proven that consuming sugar substitutes negatively affects the dopamine system of the brain and the amygdala, disrupting their function. Look at the picture - you can see how much more "frying" the brain is done by sweeteners than by sugar! (Physiol Behav. 2012 Nov 5;107(4):560-7. Altered processing of sweet taste in the brains of diet soda drinkers). Yes, the authors write that "that there are alterations in reward processing of sweet taste in individuals who regularly consume diet soda, and this is associated with the degree of consumption. The more sugary drinks, the more disrupted the dopamine system. And it is related to behavior, choice, cravings and many other things that determine not only our eating behavior, but also risk assessment and multiple decision making! Also consuming sweeteners decreases the brain's response to eating other sweet foods, decreasing sensitivity to sweetness. (The human orbitofrontal cortex. Linking reward to hedonic experience. Nature Reviews. Neuroscience 2005, 6(9), 691-702.)

How does this affect our behavior? Directly. In this study, scientists studied how our choices are affected by drinking water, sweet water, and water with a sugar substitute (very interesting article, I recommend The effect of non-caloric sweeteners on cognition, choice, and post-consumption satisfaction Appetite 83 (2014) 82-88). It turns out that sweeteners act very differently than sugar water! Most of the studies done have too short a time frame to notice this effect, as it develops gradually. So, people who have consumed a sweetener are more likely to choose high-calorie foods during the day! The group that consumed SS was 2.93 times more likely to choose candy than the group that drank regular or sugar water!

There's a lot of other work on how sweeteners affect our behavior, other than sugar, but that's a topic for a separate study. I'll focus on this interesting work on how sweeteners affect the prefrontal cortex, decision making in the future discounting model, a well-known effect. Sugar substitutes devalued the future and shifted the focus of attention only to short-term goals compared to sugar (Psychol Sci. 2010 Feb;21(2):183-8 Sweet future: fluctuating blood glucose levels affect future discounting).

Conclusion. Cheating your body is bad for your health! Eat whole, "honest" foods that communicate accurate information to your satiety system and help you make healthier choices in the future. After all, our health is not a sprint, but a marathon, so we should especially think about the impact of certain actions on our habits, choices, and behaviors in the future.