Katrina Ubell:     You are listening to the Weight Loss For Busy Physicians podcast with Katrina Ubell, MD, episode #57. Welcome to Weight Loss For Busy Physicians. The podcast for busy doctors like you get the practical solutions and support you need to permanently lose the weight, so you can feel better and have the life you want. If you're looking to overcome your stress eating and exhaustion and move into freedom around food, you're in the right place.

Katrina Ubell:      Hey there. How are you my friend? Welcome to the podcast today. Today is one of those days where it's super duper rainy and dark. It's not even 9:00 yet, and it still doesn't even seem like the sun has risen. I was getting ready this morning and I looked out the window and it was still pitch black. I thought to myself, “Did I get up an hour early by accident or something? What is going on?” I literally checked the clock, because I was sure. It's just one of those days where it's pouring. All the snow is going away. Boo-hoo, but we skied this weekend and had a great time, so glad we got some of that skiing in. We were driving to school, and my oldest son and I were sitting there yawning. Our brains are just like, “Nope. Time to go back to bed. Not time to get up yet.” Anyway, I feel cozy, and comfortable, and ready to talk to you today about a really good topic that I think is going to shed some light onto why our lives are the way they are and why we have the struggle that we have.

I don't know about you, but for me, especially with my scientific analytical mind, when I really understand the background for why what I currently have is there, then I can understand and more easily apply the concepts needed to change it. I have a hard time blanketly accepting things. I just need to understand and have that rational and logical conceptual understanding, and then I can move forward with it. I realized I hadn't really shared this with you. I was talking with one of my groups about this issue and I realized, “Wow, I haven't taught this to those of you who listen to the podcast,” so I wanted to make sure to do that today.

Very quickly, I just wanted to talk about iTunes reviews. If you would be willing to leave me one, I'd appreciate it so much, because it really helps other people to find the podcast as well. The one I wanted to share today is by someone who writes here name as I Heart Wisdom From Katrina, which is very sweet. The title is Soul Sister. She writes, “I look forward to Tuesdays. As a fellow pediatrician, I feel like Katrina is speaking to me on so many levels. Encouraging to know I'm not alone in my mom/doctor/wife struggles. I learn something every single time that I listen. Thank you, Katrina.”

Yeah, you're so welcome. Listen, that is such a huge part of this, is this idea that we are so isolated. We think we're the only ones. We think everybody else has it all figured out, and we're the only ones who haven't gotten the secret message or the beam of light from the heavens, “This is how you do it.” I think that makes such a big difference when you recognize, “Oh my gosh. I don't need to be ashamed of this. This is how all of us are to some extent or another and we're all just figuring it out.”

I don't know if you've had this, if you're a parent, if you have this kind of revelation, but at some point, I had this revelation where I realized, “You know what? There is no parent out there who really knows what they're doing. Even our parents, they were just winging it the whole time, just like we are.” It made me have even more compassion for my own parents. Like, “They're just doing the best they could, just like I am. They screwed stuff up just like I am.” It's okay. It's how it is. It's totally fine.

All right. Let's talk about pleasure. Pleasure is important for humans. Why do we experience pleasure? We experience pleasure so that we will survive as human beings. This concept of us experiencing pleasure is very primal and very necessary. It's been something that humans have been experiencing from the beginning. It's so important, because it helps us to make sure we meet our needs. When we do something that cause dopamine to be released in the brain, that lights up our pleasure centers, and it makes us feel really good. Then, our brain creates more design for that initial action, the action that created that dopamine release. The brain takes note of that and goes, “That was really good,” and says, “You should definitely do that again.” Our brains encourage us to do these activities, these actions again and again by creating desire for that thing, and sometimes urges as well.

Desire is when we want it; urges is when we really, really, want it. They're kind of the same thing, but an urge is when … I feel like an urge is when I feel like someone's hand is on my back pushing me like, “You should do that,” versus desire is a little less forceful. That's just how I think about it. You might think about it in a different way, but they're basically … They're cousins, or maybe even relatives. Maybe they're sister and brother. They're very closely related.

There are natural pleasures that we get as humans. The net effect of partaking and experiencing that pleasure is positive for us. Let me give you that list of what the natural pleasures are. Again, if you would like to see this in written form, the transcript is always available for every episode on the show notes page. You can find that just by putting forward slash and the episode number after the episode. In this case, you can find the transcript at katrinaubellmd.com/57. Then, you can take a look at this if you want to write this down for yourself. You can download it or just read it.

Okay, so these are the natural pleasures:

Eating fuel foods, so food that is fuel for our bodies.

Resting.

Exercising, and by exercising I mean moving our bodies. I mean not just sitting on the couch all day. It could just be just getting up and doing things. It doesn't mean running a marathon necessarily. Although, for some people, I think they do get a lot of natural pleasure out of doing that. Most of us don't, I would say.

The next one is connection with other humans. Very, very, important.

Sex.

Cleanliness. Think about how good a nice hot shower feels. Even better, how good it feels when you haven't showered for a few days. If you've ever gone camping or even just being on call in the hospital, you get home, you just feel gross. You just don't feel that great and having that nice shower does make you feel better. It really does create some natural pleasure for you.

The next one is accomplishment. Think about how you felt when you graduated from medical school. That was a big accomplishment. Most people are not able to accomplish that, or don't do what's required to accomplish that. We feel really good about that. That net effect, that pleasure, continues on and on. The last one is adventure, having some kind of exciting new things in your life, having new experiences.

These are all things that drive us to keep ourselves alive and keep the human race going. Think about it. If we had no drive for accomplishment as humans, then we wouldn't have all the amazing discoveries and inventions that we have. We'd still be living in a cave. We'd be lucky if we had fire. We would just be like, “Mm-mm. Just doesn't seem like it's worth it to try to make anything better.” It's basically what depression is. There's no hope. What's the point? We'll just stay here and just not ever change anything, make anything better.

When you think about each of these things, they really do give you pleasure. Think how good it feels to have a nice amazing rest, like a whole really good night's sleep. You wake up and you just feel like, “Ah, that was good. I'm so glad I did that.” You're never regretting like, “I really wish I hadn't slept those eight hours, because now I feel terrible. I wish I'd only gotten 4 1/2. I wish I'd gotten woken up by the pager 20 times last night.” No. Of course not. We feel so good when we have that experience.

When we eat food that's fuel for our bodies, we feel so good. I remember, one time, when I was a resident, I had to be on-call over Christmas. The way our residency program did it, you either did either a Q2 call schedule every other night for a couple of nights over Christmas or over New Year's. Then, what that meant was that you got the other couple of days off. It was nice, because you actually got a little stretch of time off, but then you had to pay for it by working overnight in the hospital for the other times. I remember, I think of my three years of residency, twice I had to work over New Year's, and then one year I had to do Christmas. That year, on Christmas day, I was on-call, and I just did not think ahead, apparently. I don't know what I was thinking. I made a lot of assumptions, I think is what it was. When I get in trouble with my thinking, it generally very often is related to me making all kinds of assumptions that were not wise. I see that as a trend for myself, now.

Anyway, what I thought was that they would, A, have the cafeteria open so that we could get some real food, and I also just assumed, since all the nurses brought in so much food, I thought for sure they're going to have a spread. Somebody's going to have put together some potluck something for Christmas, and I'll just be able to nibble and partake in that, and that would be fine. I think I was also feeling a little bit sorry for myself for having to be on-call at Christmas and just didn't want to put in any effort in taking care of my own needs or bringing my own food in.

I get to the hospital and dinner time rolls around. The cafeteria is closed the entire day. There's literally nothing open otherwise. All the nurses had brought in was cookies and sweets, candy, all of that stuff. There weren't even really pretzels or even anything not sugary. I found it so interesting. We often think, “Oh. I just wish I could eat all the sugar I wanted.” You know what ended up happening was I ate some of that, and then I started feeling gross. What I really just wanted was food. I just wanted a hot meal of food. That's desire for eating fuel. I didn't want all that sugar anymore. That was, I think, one of the first times in my life I ever experienced that where I really realized, “Wow, I really would sometimes rather have real food rather than just eating this sugar and junk,” no matter how good it is, no matter how delicious it is. At a certain point, it's just enough. You feel gross. All that to say, we do get a lot of natural pleasure from eating good healthy fuel food.

You think about connecting with other human beings. Loneliness is a huge problem. It totally sets you up for depression, that isolation is not good. We know that connecting with other humans is a way that we get natural pleasure. Even when you're an introvert, even when you're very shy, or feeling outgoing, you still have those couple people in your life that you like to connect with. Doesn't mean you have a million people you connect with, but you connect with some humans. That is also important.

Even having sex. It makes sense that having sex would feel good, because without it, we can't have babies, and without having babies, then the human race would be extinct. Completely makes sense that there would be a drive to do that.

Just like I mentioned, accomplishment and adventure, those are the things that drove our ancestors to go out into areas they hadn't experienced before, explored before, to find new things, create new things for us, to make our lives as comfortable as they currently are. All of these natural pleasures create good things for us in our lives. They drive us to keep ourselves alive and keep the human race going. If we had no drive for accomplishment, then we really wouldn't have all of this amazingness that we have.

For all of these natural pleasures, when you think about them, you have to earn them. You have to exert some effort to have that pleasure. You have to actually get up and get into the shower. You have to work hard so you can accomplish something. You have to actually get ready for bed so that you go and lay down in bed. Isn't it so fascinating how we're so tired and then we resist going to bed? We just don't have the activation energy to get up off our butts and go get in our pajamas and lay down in bed. It's so fascinating. Even fuel food, it is getting easier and easier, because you can buy the stuff in some places, but it does require you to seek it out. It requires you to prepare it in some cases. That takes more effort.

In our current world, what we as humans have figured out is a way to gain this system. What I mean by that is that we've created lots of ways of having concentrated versions of this pleasure but in artificial forms. Our brains have not evolved to keep up with how rapidly our role has changed and how all of these concentrated pleasures have come into our existence. If the activities that create natural pleasure gives you a modest amount of pleasure, then these concentrated forms of pleasure give you a huge amount of pleasure. Say, it's a scale of 0 to 20, then your natural pleasures maybe give you a 5 to a 7 on that scale. The concentrated pleasures give you more like a 10 to a 20 on that scale.

Let me just tell you what these concentrated pleasures are:

1. Sugar and flour.
2. Alcohol.
3. Drugs of all kinds.
4. Video games.
5. Gambling, and really other risk taking behaviors.
6. Shopping and the debt that goes along with that, so over shopping. (Shopping to buy the things that you just need in your life is obviously fine.) Overspending, looking for that dopamine hit from having something new.

Finally, social media, because it's not enough to have some friends that you have to make an effort to see. What you can now do is just tap this app on your phone and feel like you're being connected to other people, but that connection's certainly not nearly as meaningful.

Since these things are so concentrated, the pleasure is very, very, potent, and the brain really, really, takes not of this. All of these things are fast and easy. The opposite of those natural pleasures. Sugar and flour are everywhere and in everything. We can always get a drink of alcohol somewhere. It's so easy. It's so easy now to shop. Given the choice, we'll always want to go for lots and lots of pleasure that's quick and easy. That's our primitive brain that's been programmed from the beginning of humans to function in this way. We will always want to choose the concentrated pleasure.

Like I said, who really cares about accomplishing something when you have drugs that can make you feel this amazing? If you have heroin, which is apparently the most amazing pleasure you could ever experience in your life, why would you try so hard to get a degree in medicine? It just doesn't make sense. We see that play out in drug addicts lives.

Who cares about cleanliness when you can play video games endlessly for days? Why connect with your spouse for sex when you can just watch porn any time you want. You don't even have to put forth really any effort. Why eat fuel food when you can have sugar and flour, and it makes you feel like all your troubles are just melting away. Why drive to a store and actually walk around, and select things, and pay for them, when you can just shop online in your jammies in front of the TV with a snack and a glass wine. You're always going to go for that easy, easy, solution.

Now, I will say that some people are more predisposed and highly sensitive to pleasure from different forms than other people. Naturally thin people don't get the same pleasure from food, any food really, but especially sugar and flour, that those of us who overeat do. They just don't really care. I remember thinking, “These people who just don't like sugar, what would that be like?” People who are not dessert people, what would that be like? That's just so boring to me. Then, I don't get an dopamine hit from gambling at all. It does nothing for me, but lots of people really do. It doesn't mean that necessarily all of us get this huge dopamine release from all of these concentrated pleasures, but pretty much everybody is going to have at least one thing on there that does something for them. For instance, for some people shopping is a major dopamine hit. Then, other people would rather get their dopamine hit from seeing their bank account total rise. They're like, “Look at all the money I have. I feel amazing. I don't want to buy all those things.”

When we participate in the concentrated pleasures over, and over, and over, again, our brain thinks that these things are of increasing importance and that the behavior of taking part in that pleasure is something that we should do all the time. Over the course of time, it just becomes automatic. It's not so much of a thought or a choice at the forefront of your mind. You are making that choice every day, every time you take part in it, but it's so down regulated in terms of just happening automatically in your neural connections that you just don't even think about it. It's just habit. It's what you do.

You just go get candy in the hospital gift shop pretty much every day just as part of your routine and you don't even think much about it at all. Even if you do have a thought that maybe getting that candy isn't the best idea, then your primitive brain, which wants you to have that pleasure, because it's very, very, important, it'll quickly give you all kinds of reasons why you deserve it, you can have it just this time, it doesn't really matter, you won't have anymore starting tomorrow, that whole logic and argument, and then the brain just repeats that argument every day. Then, it's just like, “Yeah, starting tomorrow, I'm not going to do that,” and then tomorrow rolls around and it's the same thing, “Well, today I'll have it and I'll stop tomorrow.”

The question really comes down to, where do you want to get your dopamine from? Because whatever you choose will perpetuate itself. When you choose the natural pleasures over and over again, at a certain point that natural list of pleasures and the amount of pleasure you get from those things becomes enough. It becomes your normal cycle. It just is how you operate. It's just our preference is then for the way we've evolved to function, the way we're supposed to be as humans operating. That becomes our preference.

This is what's so interesting. We think we really love our sugar, but what we really love is the dopamine release. This really was not a problem until modern food hit us in the last number of decades where sugar and flour is available everywhere and is in everything. It actually is much harder to not consume it than it is to find it in everything.

Interestingly, our prefrontal cortex, which is the part of our brains that's rational and human, makes us human, it created the concentrated pleasures. They're all manmade. When you look at them, none of them are naturally occurring. The best news is that we can use that same part of our brain, the prefrontal cortex, to get us out of this situation. The part of our brain that got us in is the exact part that's going to get us out.

It's also important to recognize that the artificial list of pleasures, they're really just the counterfeit versions of the real thing. We've desensitized ourselves to the natural forms of pleasure and convinced ourselves that the counterfeit is the best that we can get. It's so amazing, it definitely is what's most important. We want to want the real thing, the natural version, because the natural pleasures get us what we really want in our lives. The net effect is positive for us.

With the artificial pleasures, the more that you do them, the more you partake in them, the more desire you experience and the less pleasure you experience when you partake in them. Think about that. At first, the first time you're a baby and you experience sugar, even just fruits, it's like, “Oh my god! This is amazing.” The more you eat candy and the more you eat all those sweets, you need more and more sugar to get that same pleasure. It just becomes normal to eat all of that sugar. Then, you're still not even getting that much pleasure from it, and you start looking for it in something else.

You drink more and more alcohol, or you spend more and more money, or you do more and more drugs. That is how drug addicts end up overdosing, because they initially got the most amazing high and as they go along those pleasure receptors in the brain actually down regulate, meaning you need more and more of the drug to get that same high. They're always chasing that first initial amazing high. In doing so, they overdose. Now, for us, we just eat more and more sugar, and then we gain more and more weight. People might drink too much alcohol. Now, it's really starting to affect their lives, or they're spending so much money that now they're really getting into debt, or their house is ridiculously cluttered with a whole bunch of stuff they don't even need or want.

Now, the opposite is true of the natural pleasures. The more you do them, the more you partake in those activities, the less desire you have for them and the more pleasure you get from doing them. It feels more and more amazing the more you do them. We need to practice that natural list so that it becomes enough, so it becomes enough pleasure so we can drop the artificial list and meet all of our needs on that natural side. That is what we're aiming for. So when you're feeling restless, and you're wanting some pleasure, and you don't know what else you can do, take a look at that list. What can you do? I'm telling you, it's just some of the basics. Take a shower, go to sleep, talk to a friend, have sex with your husband, or your spouse, or your partner, those things alone. So many of us think, “Ah, we don't do those enough. We need to be doing more of those things.” That will bring a lot of natural pleasure into your life that gives you the results that you want, so important.

I finally want to touch on one other thing. What's so interesting to me is how we often downplay some of the things that give us natural pleasure. I want to talk about that sense of accomplishment from having graduated from medical school. What I find is that we feel pretty proud of ourselves when we first do it. We're like, “Yeah, I'm pretty amazing. Look what I just did. That was awesome.” Because so many of us have been raised to be humble and not to make a big deal out of ourselves, we just downplay it. We're like, “Yeah, yeah, yeah, I did that, but it's not a big deal.” What I find so interesting is my coaches told me, she's like, “If I were a doctor, every day, I'd be just walking around being like, ‘Listen people. I'm a doctor. Do you know how amazing I am? Look what I did, what I accomplish, and what I do every single day.'”

I bring babies into this world. I cure people's cancer. People come to me all torn up from a car accident and I put them back together again. People come to me with babies who don't sleep, who have all kinds of problems, and I talk to these people, and then they fix it. I'm obviously exaggerating, but seriously, what we're offering as physicians to the human race is so fantastic, but it's so normal to us that we completely downplay it and completely deny ourselves the pleasure of having accomplished that. We're like, “Oh yeah, I got this nice card from this family saying that their experience with me was so great, but so and so is mad, and these people are upset because I was 20 minutes behind.” Our brains just want to show us all the things that we haven't done well. By doing so, we're depriving ourselves of that natural pleasure of accomplishment.

I want you to really think about that. When was the last time you really gave yourself a pat on the back for all the amazingness that you offer this world? It's not in a way that's prideful, or arrogant, or hoity-toity, or anything like that. It's really just going, “Look at this amazing life I've created for myself. I was able to do this incredibly hard work for years, and years, and years, to get to the point where I am now. Then, I've accumulated all this amazing experience on top of it, and the value I provide to the human race every single day is just amazing. I'm so incredibly lucky, and privileged, and blessed, to have this life.” That is natural pleasure. I want you to really think about that. Think about giving yourself a little fist bump. Just that pat on the back going, “You did it, mama. You seriously did it. Once again, look at how amazing your are. These people are so lucky to have me helping them change their lives for the better, to be healthy,” which is so, so, important.

Okay, guys. So good. So glad to be able to talk to you about this. If you have any questions about this or comments, bring them to the show notes page, katrinaubellMD.com/57. You can also find the transcript there, which might be helpful if you want to make a little list of these things for yourself to reference for the future. All right, can't wait to talk to you next week. Have a great one. Take care. Bye-bye.

Thanks for joining me today. If you like what you heard here, be sure to hit subscribe in your podcast app so you never miss an episode. You can also get my Busy Doctors Quick Start Guide To Effective Weight Loss for free by visiting me over at katrinaubellmd.com.