Behavioral health as a level of regulation

Behavioral health is an underestimated level of regulation. Many drugs, supplements, and strategies now use endpoints in the form of their target efficacy, toxicity, or 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 will not work in complex systems. After all, conscious reflection and awareness 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 assess: the more different the "must," "want," and "useful" are for you, the deeper the neurobiological conflict.

So, what to do about the dopamine system?

Of course, scientists are itching to get their hands on it - after all, there are tremendous prospects for influencing behavior. Let's look at two cases in which completely non-toxic substances are used for a "logical" primitive purpose that does not take into account long-term changes in human behavior.

One case is an attempt to block the enjoyment of food, smoking and alcohol in order to lessen the addiction.

The second case is the use of sugar substitutes (non-toxic and seemingly safe) in order to "have more fun" without the side effects on the figure.

Good idea?

Indeed, at first, everything looks harmless: from a toxicological point of view, everything is safe. But from the behavioral point of view, everything looks pretty bad.

The attempt to block the pleasures failed quickly.

So, in 2006, Sanofi-Aventis put on the market the drug rimonaband (aka Acomplia, Zimulti), which blocked cannabinoid receptors type 1 (CB1), reducing the pleasure of eating and, accordingly, the craving for overeating. In addition to overeating, the drug also reduced cravings for drugs, alcohol, and helped to 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 stimulating 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 many 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.

Is it worth the trouble?

According to the World Association of Dietitians, the weight of obese patients in a year of systematic use of the drug decreased by 5%. Other "miracle pills" also work: in 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 links from people who disagreed that, from a research perspective, 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 consequences of changing behavior.

It has long been proven that consuming sweeteners negatively affects the dopamine system of the brain and the amygdala, disrupting their function. The more sweeteners, the more disrupted the dopamine system is. And it is related to behavior, choice, cravings and more, which determines our not only eating behavior, but also risk assessment and making a lot of decisions!

Also, consuming sweeteners decreases the brain's response to eating other sweet foods, reducing sensitivity to sweets.

How does this affect our behavior?

Directly. In this study, scientists looked at how our choices are affected by drinking water, sweet water, and water with a sugar substitute. It turned out that sugar substitutes act completely differently than water with sugar!

Most of the studies done have too short a time frame to notice this effect because it develops gradually. For example, people who consumed a sweetener were 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 are many other papers on how sweeteners affect our behavior, as opposed to sugar, but that's a topic for a separate study.

I will focus on a curious work on how sugars affect the work of the prefrontal cortex: decision making in the model of "future discounting" - is a well-known effect.

Sugar substitutes devalued the future and shifted the focus to only short-term goals compared to sugar.

Conclusion: Cheating your body is bad for your health!

Eat whole, "honest" foods that communicate reliable 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.