I finished Dopamine Nation: Finding Balance in the Age of Indulgence, by Anna Lembke, MD. She writes about the delicate balance between pleasure and pain, and why now more than ever finding balance is essential. "We’re living in a time of unprecedented access to high-reward, high-dopamine stimuli: drugs, food, news, gambling, shopping, gaming, texting, sexting, pornography, Facebooking, Instagramming, YouTubing, tweeting… The increased numbers, variety, and potency is staggering. The smartphone is the modern-day hypodermic needle, delivering digital dopamine 24/7 for a wired generation. As such we’ve all become vulnerable to compulsive overconsumption."
Dr. Lembke explores new scientific discoveries that explain why the relentless pursuit of pleasure leads to pain…and what to do about it. Finding contentment and balance means keeping dopamine in check.
The scientific findings may be new, but the knowledge is ancient. “The good and the pleasurable are two different things," wrote the author of the Katha Upanishad in the 5th century, BCE. "They motivate a person to pursue two different goals. The one who embraces the good meets with auspiciousness. But the one who embraces pleasure is lost.”
I neither seek pleasure nor shun pain. Sometimes I seek pain and shun pleasure. I broke a 2 day fast. Fasting is one of the disciplines in my regimen. They last from 1 day to 2 weeks. I fast at the urging of the Soul, which dictates the duration and terms. I fast for clarity, for penance, for cleansing, for insight, to discipline the body and to restore balance to the mind. By balance of mind, I mean a reseting of the molecules that control motivation, reward, focus, and attention.
There are benefits to fasting. Fasting promotes blood sugar control by reducing insulin resistance; improves blood pressure, triglyceride and cholesterol levels; reduces inflammation; protects brain health; boosts metabolism; increases growth hormone secretion; and slows the aging process. After 12 hours of fasting, I'm rewarded with a 5 fold increase in human growth hormone. After 16-18 hours, I experience an increase in insulin sensitivity and autophagy/cellular repair. My metabolism increases; reductions in plaque forming amyloids contribute to heart health, and increases in brain-derived neurotropic factor (which aids in the growth of new brain cells) contribute to brain health. Sometimes, I will prolong fasting for two or more days. After 24 hours, liver glycogen stores are depleted. I start running on ketones. Ketones are an appetite suppressant. After day 2 or 3, the hunger pangs are diminished. Ketones are antioxidants, which provide more oxygen. The body works more efficiently with less. Ketones are a more efficient fuel than glycogen, so the thyroid isn't working as hard. Inflammation drops. The gut gets a reprieve. After 48 hours, stem cells are stimulated which promote healing and repair. After 72 hours, I experience greater immune functioning. And my dopaminergic system gets a reboot.
The hunt for food is a motivator that predates the species, but we live in a time of over-consumption. We eat too much, and we eat too much of the wrong foods. Fasting gives my gut, body, and brain a reprieve.
Fasting also appears to change the human brain-gut-microbiome axis. The bacteria Coprococcus comes and Eubacterium hallii are negatively associated with activity in the left inferior frontal orbital gyrus. The inferior frontal orbital gyrus regulates appetite and executive functions, including willpower when it comes to food intake (Zhou, et al., 2024). The microbiome produces neurotransmitters and neurotoxins which affect the brain. In return, the brain controls what we eat. And what we eat changes or maintains the composition of the gut microbiome.
I do not subject myself to the rigors of fasting for these benefits alone. I submit the body and mind to the dominion of that innermost voice my little self trusts. 'Fasting sucks!" my little self grumbles. Still it trusts the Inner Guide which suggests we do it anyway. The Inner Voice does not demand or insist. It is gentle and strong. And I trust it. "Trust thyself, wrote Ralph Waldo Emerson, "Every heart vibrates to that iron string."
I do stuff that sucks. Daily, I practice several rounds of breath work. The breath holds are intense and uncomfortable. The body reacts to it as a stressor. I practice relaxing into it. Several times weekly, I sit in a tub of ice for 2-10 minutes. Ice baths reduce inflammation and improve recovery by changing the way blood and other fluids flow through your body. Blood vessels constrict when the body is exposed to cold; they dilate when we exit. This process helps flush away metabolic waste- including lymph, a clear fluid made up of white blood cells and fluid from your intestines. While the heart circulates blood around the body, the lymph nodes don’t have a pump. Ice baths constrict and open vessels manually, which helps stagnant fluids in the lymph nodes circulate. Increased blood flow floods the cells with nutrients and oxygen.
Cold-sensing nerves in the skin send electrical signals to a specific region of the hypothalamus called the preoptic, which regulates body temperature (Nakamura, 2008). This thermostat sends signals back to the body to initiate thermoregulation. The thermostat increases body temperature by regulating constriction of blood vessels, stimulating muscle twitches (shivering), and producing heat by burning more fuel (Nakamura, 2011).
Of course, long-term exposure to cold can cause serious damage. Even a 2°C drop in the core body temperature can cause hypothermia. At 18°C, we'll have a massive leak in our blood-brain barrier which can lower the brain’s ability to function. Our neurons and heart will die first during hypothermia because these ion transporters cannot function at lower temperatures.
But a few minutes is safe. “The combination of breath work and cold plunges is very effective,” says Kevin Davison, a Maui naturopathic physician who specializes in regenerative medicine. “First you’re increasing lymphatic flow through the breathing. That recruits lymphocytes and natural killer cells into the bloodstream—they’re the cells that are out there looking for invading bacteria, viruses, and pathogens. Then the cold plunge kicks that in even more. So you’re getting your whole system jumped up to the next level of immune protection.”
But, as with fasting, I do not subject myself to the discipline for these benefits alone- as beneficial as they are. "Doing things - even small things - that make you uncomfortable will help you get strong," asserts ultra-athlete David Goggins.
Breath work sucks.
Cold immersion sucks.
We do it anyway.
Relaxing into an ice bath takes my meditation training to another level. It is easy to remain equanimous sitting on a comfortable cushion in a quiet room. It is more challenging to relax and remain centered when exposed to a stressor as primitive and primordial as cold. "The cold is my guru," Wim Hof said. It can teach you.
In Dopamine Nation, Dr. Lembke references a 2000 study published in the Journal of Applied Physiology. Participants were submerged in cold water (57°F/14°C) for an hour. Plasma dopamine concentrations increased 250 percent (equivalent to a few lines of cocaine). Plasma norepinephrine concentrations increased 530%. The increase in dopamine, interestingly, was gradual and persisted over time, unlike drugs which not only cause a spike in dopamine, but subsequent crashes and tolerance over time.
A recent study found that taking a 5-minute bath in cold water can make people feel more active, alert, attentive, proud, and inspired, while also reducing feelings of distress and nervousness. This increase in positive emotions was linked to changes in neural connectivity including the medial prefrontal node of the default mode network, a posterior parietal node of the frontoparietal network, and anterior cingulate and rostral prefrontal parts of the salience network and visual lateral network (Massey, et al., 2023). Extreme cold promotes neuronal growth. Drug dependence, by contrast, leads to neuronal damage and death. Choose your suck.
Disciplines like fasting and breath work expose body and mind to stress which builds resilience. Exposure to hunger or cold triggers hormesis, a biological response to stressors that is both stimulating and beneficial. “The vagus nerve is linked with the parasympathetic nervous system, and training it can help you face stressful situations more adequately,” says Nick Clayton, program manager for the National Strength and Conditioning Association. In a recent study, researchers found that short, 5-minute bouts of stress can reverse the effects of chronic stress at the level of glucocorticoids, hormones, and neurotransmitters. Repeated exposure to disciplines like breath work and cold exposure builds resilience.
Many choose the suck over comfort. It's more common than one might think. Examples abound: a woman chooses the pain of childbirth, initiates take vows of celibacy and poverty to become monks or nuns, a man shoulders an extra job to send his son to college, runners punish their bodies to complete a marathon, students postpone gratification to obtain degrees, athletes grunt and collapse in fatigue after intense workouts, an investor practices frugality to save more and build wealth, recruits endure weeks of bootcamp to become soldiers, millions forgo their favorite foods to promote their health. Within this context, disciplines like meditation, fasting, and ice baths are not so unusual.
Understanding how the brain seeks to balance pleasure and pain is vital to our well-being. Pain and pleasure are processed in the same area of the brain. The ability to recognize and respond to potential rewards or punishments depends in part on a part of the brain called the ventral pallidum. The balance between signals that either inhibit or excite neurons in the ventral pallidum appears critical in controlling motivation.
The neuromodulator dopamine modulates our subjective experiences of pleasure and pain. Dopamine amplifies the activity of brain circuits associated with pursuing goals, motivation & reward. When dopamine levels rise above baseline, we experience pleasure. When they fall below baseline levels, we experience them subjectively as pain. Pleasure often gives way to pain, and pain to pleasure.
The neurotransmitter GABA (gamma-Aminobutyric acid) also seems to play a role in reward seeking. Neurons that use the neurotransmitter glutamate to excite brain circuits appear essential for avoiding punishment. Both respond when we're presented with the potential for both punishment and reward.
Take exercise, for example. Exercise is a stressor. Exercise is toxic to cells, leading to increased body temperature, noxious oxidants, oxygen deprivation, and lower levels of glucose. Yet, exercise promotes health and in the absence of exercise we deteriorate. Exercise boosts levels of dopamine, serotonin, GABA, glutamate, norepinephrine, epinephrine, endocannabinoids, endogenous opioid peptides, and BDNF (brain-derived neurotrophic factor). BDNF supports glial cells which provide neuroprotection.
"From a metabolic standpoint, vigorous exercise is the most demanding activity the brain encounters, much more intense than calculus or chess, but nobody knows what happens with all that energy," said Richard Maddock, professor in the Department of Psychiatry and Behavioral Sciences at UC Davis. "Apparently, one of the things it's doing is making more neurotransmitters."
Exercise sucks. Our bodies can withstand hardship, stress, hunger, cold, and other privations. But we've pampered our bodies in pursuit of pleasure. Embrace the suck!
What we call willpower or tenacity has a biological substrate. Evidence suggests a central role for the anterior mid-cingulate cortex in subserving tenacity. The anterior mid-cingulate cortex acts as a structural and functional hub connecting multiple brain regions that render the experience we call persistence, or will power, or tenacity (Barrett et al., 2020). The anterior mid-cingulate cortex also receives a wide range of signals from other brain regions. in other words, it influences and is influenced by rest, memory, emotion, mindset, interoception, etc. Together, they regulate the amount of effort directed toward any potential behavior. What we call tenacity will influence performance particularly wherever there is challenge. Intentionally doing things that suck every day strengthens these networks and the volume of the anterior mid-cingulate cortex. Imagine your brain growing muscles.
Daily, I sit to meditate, and I meditate several times throughout the day.
"If it doesn’t suck, we don’t do it," asserts David Goggins. "I’m all about callusing the mind. Do something that sucks." Embracing the suck was the tagline of a retreat I led in the spring. "For most of us, meditation is like being kidnapped by the most boring person on earth and being told the same story over and over again," wrote Sam Harris.
But boredom offsets the constant stimulation we seek. Boredom resets the pleasure-pain balance. Sometimes we just need to sit through the suck. Learning to be comfortable when boredom arises is a useful skill. Like this, we train ourselves to stop reacting to external stimuli. We strengthen the neural networks that promote inhibition and non-reactivity- the stop-brain. This is a path to self-mastery, and it gives us some degree of control over our dopamine schedules, such that when it is time to pursue a goal- we can throttle the go-brain... but stop when we need to stop. This is self-discipline.
It is misguided to think the pursuit of pleasure and the avoidance of pain will bring happiness. I have found the opposite to be true: pain and discomfort and struggle can be the path to peace and joy and strength, while the pursuit of pleasure often leads to numbness, dissatisfaction, distraction, and dissipation. This is ancient wisdom. The 13th century Persian poet wrote:
"Be warned, intoxicated lover. You are unaware that you are on the edge of the roof. Disaster may come suddenly. You may not see the edge, but the Spirit does, and fears that your unawareness signals the start of your descent. All sudden shocks, calamities, and deaths occur on the roof of enjoyment."
There is a Zen quote that says: "The search for happiness is one of the chief sources of unhappiness."
Choosing disciplines that suck like exercise, diet, fasting, frugality, meditation, or cold exposure offsets the suckiness of poor mental, physical or financial heath. We each have our own journeys, unique biochemistryEvery moment contains within it a probability. A new breath comes, a new moment comes, new choices present themselves. The choice not to choose is itself a choice. Life demands you choose. Choose your suck.
Originally published 6/29/2020. Updated 11/7/2021