Usually my patients express a sense of relief when I report that their blood test results are normal. But sometimes they seem strangely disappointed. They’ll say things like, “Oh well, I guess that’s good, but now I won’t be so motivated to do the (fill-in-the-blank) healthy behavior that I was wanting to do.” It’s like they needed to be scared by the concrete evidence that something was wrong, in order to choose to become healthier.
I must say that in over thirty years in primary care, I’ve learned that fear is NOT a sustainable motivator. It’s not that getting scared by a lab report doesn’t get us to focus on our health. But it only works in the short term, and there are a couple of reasons for that.
Fear as motivation
The first reason is that blood tests are actually quite a blunt measure of health. We believe that getting a “physical” or “check up” should be an accurate and comprehensive overall measure of health. But actually such panels are typically designed to find out if there is something seriously wrong. In other words, routine screening tests are typically designed to look for major abnormalities that could be life-threatening or which require prescription medication. While testing for subtleties or nuances in health and well-being does sometimes exist, such tests are often less well validated, and thus not covered by insurance.
Fear is NOT a sustainable motivator
Another reason is that while unfavorable lab reports like high blood sugar can motivate short term changes in diet, it’s usually harder to sustain such choices over time. As humans, we have evolved to retain fear as short term motivation to avoid threats, like predators or toxic plants. But over the longer term, our brains are even more strongly motivated to seek out pleasure. This is why the addictive cycle can be so powerful - despite experiencing clear and present danger, addicts will continue to put themselves in harm’s way for that dopamine hit.
Don’t get me wrong, I’m not saying that fear can’t be a powerful and effective motivator. Many people make major changes in health behaviors based on fear. They may exercise a lot more or lose weight, but it’s often harder to maintain that weight loss. Sometimes it can be because of disappointment, when their follow up blood tests don’t reflect as big an improvement as they believed it should. But more often, it’s because the danger doesn’t seem as scary as it did before, or perhaps the lure of craving the old pleasure overruns the fear.
Owl versus cheese
The problem with relying on fear alone as motivation is that, while fear pushes us to run away from what we fear, it doesn’t keep us going in that direction. In their book Burnout, Emily and Amelia Nagoski cite the famous 2005 Friedman and Forster study where college students were asked to solve maze puzzles with a cartoon mouse that is either trying to escape an owl overhead or trying to find the reward of cheese.
When we are running away from the owl’s talons, any direction will do and the motivation to run evaporates once the perceived danger is gone. But if we running toward the rewarding goal of cheesy pleasure, we will keep trying repeatedly to find it, even if we have to hit every dead end in the maze, in order to get there.
When my blood test results showed that I had borderline prediabetes, my initial reaction was fear. Fear of getting diabetes, fear of having to take medications, and fear of all the complications of diabetes, like blindness, kidney failure requiring dialysis, or nerve damage leading to amputation. I also felt guilty that I hadn’t been “watching” my diet or my weight. I was motivated to cut back on sugar and carbohydrates, and it even worked to help me lose some weight.
But then when I went back to get my blood tested, my blood test was still abnormal.
And then my human brain made it mean that nothing that I did had made any difference, so why bother? This is the most common scenario for many of us. But even if my blood sugar was back in a normal range, my sense of safety and gratification would still lead me to conclude that I was safe. After all, I had expended sufficient effort, and all those dangers I was worried about didn’t seem particularly imminent.
When we are running away from the owl’s talons, any direction will do
I had become desensitized to the fear. But more importantly, the old reward centers that were connected to my brain’s dopamine receptors were craving that hit of pleasure that came from consuming sugar and carbs. Not only had my brain been conditioned from an early age with the message that “Food is love,” but I had spent countless hours celebrating with sugary cakes and cookies. I had sought refuge from those rough teen years with rice and noodles made by my amah and escaped into the comfort of pizza-induced carb comas for most of my adult life. Food not only represented love, it was my BFF (best friend forever).
It’s like sugar was somehow both my owl and also my cheese. It represented danger to me, but it was also a huge source of comfort and pleasure.
I had become desensitized to the fear. But more importantly, the old reward centers that were connected to my brain’s dopamine receptors were craving that hit of pleasure that came from consuming sugar and carbs. Not only had my brain been conditioned from an early age with the message that “Food is love,” but I had spent countless hours celebrating with sugary cakes and cookies. I had sought refuge from those rough teen years with rice and noodles made by my amah and escaped into the comfort of pizza-induced carb comas for most of my adult life. Food not only represented love, it was my BFF (best friend forever).
It’s like sugar was somehow both my owl and also my cheese. It represented danger to me, but it was also a huge source of comfort and pleasure.
Momming my brain
So how did I break free of this Catch 22 situation with sugar? The first crucial step was becoming aware that I was even caught in this cycle. When I became aware of how dependent I was on sugar and carbs, I also began to see how there was a vicious cycle at play: the more carbs that I had, the more I craved.
At that point, I had to ask myself whether Food was really as good a friend as I had always thought. I took a very gradual approach to reducing carbs, starting with cutting back on sugary drinks like juice and soy milk, and then sweets and cookies. But as I gradually cut back, I noticed less fatigue and more mental clarity on the days that I was on my game.
It was harder to cut back on rice, and even harder to give up bread and noodles, but when I did, my skin cleared up and my gut got a lot quieter. Not that I never eat carbs or sugar, because I definitely still have good and bad game days. But it’s interesting to see how my body responds when I do indulge. There’s usually an initial high as all those decades-old dopamine connections light up, for maybe 5-10 minutes, but then there’s often some kind of less happy reaction. I might get a head or tummy ache, and my sleep is almost always broken up that night.
My brain function is critically important for creating that vision of my future self
I’ve learned that Food is a fickle friend at best. Sometimes she is beautiful and friendly when healthy whole foods are at hand, but she can also play fast and loose with me. Cozying up to me with a stiff dose of desire, and partnering with my people pleaser to get me to have “just a taste” of some forbidden treat. But when she’s had her way with me and sauntered away, I’m usually left with a rancid taste in my mouth, wishing that I’d stayed “clean.”
I know with my mom brain that what I really want is healthy cognitive function with good energy, alertness, memory and focus every day. And I want to protect my brain against potential injuries that can be caused by having high blood sugar, especially Alzheimer’s disease, a.k.a. Type 3 diabetes.
And I definitely prefer to get my pleasure and dopamine from my creative pursuits rather than food alone. I want to enjoy the company of my friends and family with Food, and to enjoy her when I’m traveling. But I don’t want my life to have been only about Food.
My vision of living independently, and of being healthy of mind and body at my 100th birthday, is the kind of vision (or cheese) that makes me want to keep going through the maze, even when I hit dead ends. And I’m not going to let that vision be subject to random chance. Brain care practices that are motivated by love for our centenarian selves spin us into a kind of virtuous cycle that is fueled by energy that is both renewable and self-sustaining.
Dr Em coaching tips
Take a few minutes to study the Brain Health Multipliers, paying specific attention to the three core physical elements of Sleep, Move and Eat.
How would you rate your satisfaction with each area, on a scale of 0-10/10?
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Take a few moments to jot down your numbers, and what other thoughts/feelings might be coming up for you, good or bad.
Use this as a journal prompt, the next time you are writing or planning. Which of the 3 core elements did you score best in? Which one would you want to work on? What’s a baby step you can take this week to explore that further?
Book: Burnout by Emily and Amelia Nagoski