Stephen Edward: Good morning and welcome to today on 95.5 R&B For The Lou. I’m your host Stephen Edward and joining us back on the program, Dr. Gurpreet Padda. He joins us back on [Batoto 00:00:12] today. It’s great to see your Dr. Padda. Welcome back to the show.
Gurpreet Padda: Thank you. I appreciate being here.
Stephen Edward: The last time you were here we talked about diabetes in women and the African American community. What a marvelous discussion we had. Dr. Padda. Got a lot of people to email me after our interview. I am so happy you had a chance to come back and discuss some other things that were on your plate. Today, our discussion is addiction and why treatment fails.
Gurpreet Padda: Yeah, absolutely. I think that there’s a misunderstanding of what addiction is. I think it’s very important for us to understand how people get addicted so that we can treat them correctly.
Stephen Edward: Dr. Padda, what is the relapse rate for addictive diseases and why is relapse a part of recovery?
Gurpreet Padda: So we expect patients to have relapse. But first you have to back up and ask yourself, what is addiction? Addiction is the concept that I’d go back to a drug that I was using or go back to a substance that I was using because that substance made me feel differently. It made me feel better. It’s a central brain phenomenon. It’s part of our limbic system, and specifically it’s a section in our brain called the nucleus accumbens. When we take in a substance that goes to our nucleus accumbens and we get a dopamine release, and I know I’m using all these chemical terms, but when we get this chemical release-
Stephen Edward: But you’re making it easy to understand that.
Gurpreet Padda: Yeah. So you go to the nucleus accumbens, when it gets stimulated, whatever substance I took right before that, if the nucleus accumbens dumps a bunch of dopamine, my brain says, “Hey doc, this stuff is really good. Whatever it was, this was really good.” So then you back up and you ask yourself, “What are the things that caused the nucleus accumbens to dump dopamine?” Well, the primary one when you’re a little baby is oxytocin and the mom and the baby, when they are exposed to each other, they dump oxytocin and oxytocin causes the nucleus accumbens to release dopamine. So it causes bonding and it makes people feel connected to each other. As we grow certain types of food, especially in the hunter-gatherer communities that we had for two and a half, 3 million years, if we came across something that was really tasty, the brain reinforced the behavior saying, “Hey, whatever that was that you just ate, it was really good and I’m going to release some dopamine and make you want more of it.”
Gurpreet Padda: This was all good. But then we started to refine some of these chemicals that we found in the wild. So we’ve had poppy seeds forever. We’ve grown poppy forever. It was only the last couple of hundred years that we refined poppy seed into morphine. When we refined poppy seed into morphine, then we started to get morphine addiction because we’d taken the morphine and it dumps a bunch more dopamine than we would normally expect, and all of a sudden we’re flooded with this dopamine and we go, “Hey, this stuff is really good.” So it’s a matter of perspective. We’re getting a tremendous release of dopamine. So you might think that everybody that gets morphine gets this huge amount of dopamine release and we’re all addicts.
Gurpreet Padda: But that’s not the case. Isn’t that strange? Some people become addicted and some people don’t. So there’s more to it than just the dopamine dump. I’ll give you the example. During the Vietnam War, one of our biggest fears for people coming back from Vietnam was that they were going to be addicted to heroin.
Stephen Edward: Sure.
Gurpreet Padda: Because the use of heroin in the Vietnam War was between 30 to 50% of all of the armed forces. They were exposed.
Stephen Edward: Right, right.
Gurpreet Padda: So that would have meant that we had half of the troops coming back, zombies on the street taking heroin. That didn’t happen. It was only 4% of the population. So why-
Stephen Edward: But they talked about it so much, doc.
Gurpreet Padda: They talked about it, but only 4%. So that makes you wonder why is it that only 4% of the population truly was addicted, but half of it was exposed. So that brings us to an interesting study a researcher did. What he did was he took rats and he put them in a cage, and in one side of the cage he put bottles of water and next to the bottle of water he put a bottle of water with cocaine in it. He watched what would happen. The rats would taste the regular water and they go, “Well, I need water, so I’m going to drink that.” But then they would stumble upon the cocaine water and go, “Hold on. This releases dopamine. I like this.” They kept taking the cocaine water and whether it was cocaine or heroin or morphine, whatever it was, whatever he tested with, anything that we have as an addictive substance, the rats would overdose on it and die.
Gurpreet Padda: So therefore, us as physicians concluded that if you expose a rat or a human to a substance, they’re going to overdose and die. So you would think that that would be the case. But we also know that only half of the rats, if you expose half of the rats and only 4% of them are truly addicted, what happens? So the same researcher did another study. He took the rats and he put them in a cage and he gave them water and he gave them morphine or he gave them cocaine in another set of water. But instead of just being there by themselves, he gave them things to do. He gave them other rats to have sex with. He gave them other rats to play with. He enhanced their environment. He gave them stuff to do instead of sitting in a sterile glass aquarium.
Stephen Edward: Right.
Gurpreet Padda: As soon as he did that, none of the rats died. The rats weren’t interested in the morphine, in the cocaine, heroin.
Stephen Edward: They were interested in each other.
Gurpreet Padda: They were interested in each other. The conclusion from that is the rats that are lonely become addicted. The rats that have a lot of stuff to do don’t get addicted. The same thing with humans. Fundamentally, fundamentally it’s an issue of your limbic system with the dopamine release, but it’s in the context of loneliness. When we take addicts and we isolate them because we ostracize them because they’re addicts and we make them more lonely and we imprison them, we’re only making addiction worse. Instead of ostracizing and isolating addicts, we need to treat them with love. We need to treat them with dignity. We need to bring them back. We don’t need to put them away. That’s our fundamental problem [crosstalk 00:06:44].
Stephen Edward: So you’re saying doctor, we shouldn’t put the blame on the addicts. We’re actually putting the blame on the drug itself?
Gurpreet Padda: I think the blame is in the context of where the person is and I don’t think that you should blame any of it because human beings and animals are hardwired to release dopamine. We’ve spent millions of years trying to get a dopamine release and we have these substances that cause dopamine release. But you don’t make an addict unless they’re lonely, unless they’re isolated.
Stephen Edward: I never thought about that doctor. So most of these addicts out here, or doing these things because they have nothing to do.
Gurpreet Padda: They’re bored.
Stephen Edward: They’re bored, and some of them in some cases are lonely.
Gurpreet Padda: They’re completely lonely and they’re completely bored. If you look at, and I’ve personally done this, so this may seem weird, but I wanted to see what it was like to be in a situation that where somebody was homeless. So I did a little experiment on myself. I became homeless for a day in San Diego and I wanted to see what the average person experienced being homeless. It is one of the most lonely experiences you’ve ever had because you are ostracized because you don’t have any money. You’re ostracized because they think that you’re homeless and you’re isolated and no one will talk to you and no one will interact. So it’s no wonder that our homeless population has the highest addiction rate. It’s no wonder that that’s the case. The more isolated we make human beings, the far worst the addiction and the harder it is to break. So the issue is you certainly have a chemical problem, but we have a societal problem. The only people that we have to blame is our own society for our own behavior and for not including and not loving these people that are desperate for attention.
Stephen Edward: What are some of the most addictive drugs?
Gurpreet Padda: So surprisingly, and of the hardest addictions for us to break is nicotine. It takes more quit attempts with nicotine than practically any of the other substances. That brings up something really interesting. We know that the companies that make cigarettes are really, really, really good at figuring out how to modulate and effect nicotine and effect the sales of nicotine. Those same companies are the ones that have taken over the big food corporations. That’s why since the late ’70s and the early ’80s as nicotine sales started to go down, big food sales started to go up and the food that we’re now producing is hyper addictive. You can see that because you can see that in the type of food that we have, in the glycemic index of the food that we have, in the concentration of the fructose that we have compared to what it should be.
Gurpreet Padda: So you can see it in the way that the food is manipulated to be hyper addictive. It’s because they took the information from the cigarette industry and shifted it to the food industry. It’s just fascinating. If you watch the history of food and the history of addiction and you watch it from the standpoint of what are the things that we know are hyper addictive and cigarettes are one of the worst, and they’ve shifted those resources into big food and that’s what we’re dealing with now with this epidemic of obesity. It’s an epidemic of obesity because of addiction.
Stephen Edward: Dr. Padda, what about the preservative that they put in the food? Is that part of it as well?
Gurpreet Padda: Preservatives are certainly a part of it, but I’ll give you an example that’s a little bit more specific.
Stephen Edward: Go ahead.
Gurpreet Padda: So if I take a molecule of sucrose, table sugar, okay, and I break it in half because it’s a disaccharide. It’s two sugars bounded together. So if I break it, half of it will be glucose and half of it will be fructose. So that sounds interesting to you. Glucose and fructose comes out of one sugar molecule of sucrose. Now it’s one to one ratio. Your body knows how to handle a one to one ratio. If I did a special imaging study of your brain and I looked in your brain and I exposed you to table sugar, you would get a little tiny light up of your nucleus accumbens because that fructose activates the nucleus accumbens slightly. Now, if I give you high fructose corn syrup that’s in soda, it’s not a one to one ratio. It’s 55 to 65% fructose and 45% or less glucose, and all of a sudden I get a massive light up of your nucleus accumbens. So they’ve shifted the type of sugar in the soda so it’s more addictive.
Stephen Edward: Our conversation this morning is with Dr. Gurpreet Padda. Our topic of discussion addiction and why current treatments fail. Dr. Padda, is it the glucose or the fructose that produces cancer cells?
Gurpreet Padda: Any of the sugars can stimulate the cancer cell growth. Cancer is really dependent upon sugar as one of its major influences to grow and it’s called the Warburg effect. Cancer is dependent upon these necessary elements for it to grow rapidly and one of the things it really needs is glucose and fructose. It needs both. But it preferentially prefers glucose, but it doesn’t … It’s not a big deal until you get to high concentrations. Regular amounts of glucose are not a big deal. It’s the high concentrations that you see … Because we didn’t, before 1915 to 1920, we didn’t have a huge amount of cancer in the world. Dr. Warburg, who was kept alive by the Nazis, by Hitler, Warburg was a Jewish scientist. Hitler kept him alive because he was so terrified of this rapid increase in cancer in Germany and it was because we had started to get processed food.
Gurpreet Padda: It was back then that we started to get it and it really didn’t take off until the 1960s and ’70s when we got a lot more processing of food. It became even more refined and we added vegetable oil. We added a lot of Omega-6 vegetable oils, industrial seed oils.
Stephen Edward: Dr. Padda, you and I are in the same generation. We may be the same age, but back in the day when we were growing up, cancer was known as an old folks disease. That has changed.
Gurpreet Padda: Yeah. It’s because of our nutrition. We haven’t changed our environment that much. We’ve changed it a little bit, but really what we’ve changed is our nutrition. We used to rarely hear of people being diabetic.
Stephen Edward: That’s true, so true.
Gurpreet Padda: The Joslin Institute, which is one of the preeminent institutes that studies diabetes type II, type II diabetes was rare. It was exceptionally rare and now half to two-thirds of our population is overweight or obese and half of those are going to end up with type II diabetes in the next 10 to 15 years. That’s outrageous.
Stephen Edward: It really is.
Gurpreet Padda: This is a trillion dollar problem. If we don’t fix this problem, we’re going to bankrupt this country with a lifestyle disease. Something that is easy to treat and easy to fix and what’s happened is our food is so addictive we can’t stop eating it. We can’t stop consuming it because we need it. Our brains are tricked into wanting it and it’s such a bad thing that it’s increasing our sugars constantly and as it increases our sugars, it increases our type II diabetes rates.
Stephen Edward: That’s rough, doctor.
Gurpreet Padda: It is. That’s unfortunately what addiction is. So I said, cigarettes are probably the most addictive substance and they carried that information from cigarettes into big food and here we are.
Stephen Edward: What is the disease concept of addiction?
Gurpreet Padda: So the disease concept of addiction is I need more of X, Y, Z substance because it makes me feel normal. It doesn’t me feel super normal because addiction is I need that now. I got exposed to it. It made me feel better and after awhile I go, “Hey, I got exposed to that and I need that just to be okay,” and without that substance-
Stephen Edward: Dr. Padda, the opioid problem we have here in St. Louis, is it because we’re a transit community? We have a lot of people coming in and out of St. Louis. A lot of people are sharing medications. Is that the reason why st Louis ranks so high?
Gurpreet Padda: We’re one of two states that actually has had an increase in opioid death rates in the last year.
Stephen Edward: Missouri?
Gurpreet Padda: Missouri, every other state minus one other has actually had a reduction in death rate. Missouri actually has had an increase and really what it is is the synthetic analog drugs that we have. So-
Stephen Edward: Can you give us an example?
Gurpreet Padda: Yeah, so fentanyl and carfentanil.
Stephen Edward: Oh, yeah, of course.
Gurpreet Padda: Are of course the drugs we’re talking about. Fentanyl is a synthetic opiate that we use in anesthesiology because I’m an anesthesiologist. We use it in anesthesia for cardiac operations. We use it to relieve pain during anesthesia and we use it for terminal cancer patients. It’s never really been intended to be out in the wild. It’s never intended to be used for regular patients. It was always used the requirements of anesthesia or used for palliative care for people that were terminal. But once you expose it to the wild population, once you put it in the wild, it so rapidly absorbs. It gives you such a high dopamine flux. It’s nearly the perfect drug to get that dopamine release. Carfentanil is nearly a thousand times stronger than fentanyl and fentanyl is probably a thousand times stronger than morphine. So a tiny dose of this drug is just incredible. People don’t know how to regulate the dosing on it. I’ll give you an example.
Gurpreet Padda: So there was a conflict in Russia and in Russia there were a group of terrorists that had taken over a movie theater. This group of terrorists were holding hostage several hundred people, several hundred Russians. The Russian government thought, “You know what? We’re never going to get these people out. So what we’re going to do is we’re going to gas them with fentanyl gas. We’re going to dump a fentanyl bomb into this movie theater and then we’ll run in and we know that they’re all going to stop breathing and we’ll run in and we’ll resuscitate the people that are the good people and we can then arrest the terrorist.” So they put this bomb in there, and what they ended up doing was killing almost everybody in the theater because it is so potent and worked so rapidly that they couldn’t control it. It’s the same thing with somebody who’s taking fentanyl by accident.
Stephen Edward: But doctor, if someone is having an overdose, what should they use? Naloxone?
Gurpreet Padda: So Naloxone turns off those receptors and it takes somebody who’s overdosing, who stopped breathing and immediately reverses that.
Stephen Edward: So Dr. Padda, you’ve been doing this for over 20 years. 20 years ago, the need and the popularity of using opioids were nonexistent.
Gurpreet Padda: We’ve been observing this over time. I do mostly procedures to get rid of pain and I use a very low dose medication. The medications that people are using, the medications that they’re self using are 10,000 times stronger than anything that we prescribe. The real issue, the real issue is they don’t know how to dose it. It’s the same medication that we’re using, but in anesthesia, it’s the same medication but they don’t know how to dose it. This is not like somebody smoking a cigarette. The worst thing they’re going to have is a cough and maybe develop some lung cancer. If they take a fentanyl tablet, they’re going to overdose and die and they don’t have a chance to have the remorse to figure it out. They die so quickly that they don’t have that opportunity to reverse course. That’s why the Narcan is there that perhaps we can reverse course, but this is a dose escalation phenomenon.
Gurpreet Padda: The more rapid the rise of the drug in the bloodstream, the more the dopamine release, the more the dopamine release, the more addictive the substance, the more addictive the substance, the more adherent the person is to that substance. If they have no reason not to do it, if they’re isolated, if there’s nothing else for them to do, if they’re bored, and this is what they do, if they’re hanging out by themselves, hanging out at the corner, and this is what all their friends do, if-
Stephen Edward: That’s what they’re going to do too.
Gurpreet Padda: Yeah, if this is what their tribe does, then this is what they’re going to do, and all of a sudden you have three or four dead people. Yeah, it’s the reality of what we’re dealing with now.
Stephen Edward: Dr. Padda, there’s an awful lot of clinics popping up here in the St. Louis Metro East area because now there is a problem and before, no help. Now, all the help you can get, what do you think about that?
Gurpreet Padda: Yeah, I think that the clinics, which most of them do medicated, medication assisted treatment, MAT, most of them assist the patient in reducing their craving, but that’s not the fundamental problem. The fundamental problem is that patients’ involvement in their community. What can we do? We can reintegrate people. We can give them things to do. We can give them a better hope and a better life to live for. If we continue to isolate our addicts, they’re going to die. That’s where we’re going to end up. We can’t do that. As a society, we cannot isolate these people. We’re taking away their opportunity to get jobs.
Stephen Edward: Right.
Gurpreet Padda: We’re taking away their opportunity to participate because all you’re going to do is isolate them, you’re going to kill them eventually. They have nothing to live for and we’re criminalizing, and unfortunately that’s the wrong answer.
Stephen Edward: That’s not working.
Gurpreet Padda: It hasn’t worked.
Stephen Edward: Dr. Gurpreet Padda. This is [Batoto 00:20:52] today, and we’ll be right back after this.
Steven B.: We’re back. This is Bethalto Today on 95.5 R&B for the Lou. I’m your host Steven B. Joining us in conversation this morning, Dr. Padda and our topic of discussion addiction and why current treatments fail. Dr. Padda, before we got into our break, we were talking about sugar and its addiction. What could it lead to doctor?
Dr. Padda: That’s why we have an epidemic of addiction and we have 60,000; 70,000 dead people. It’s a big deal. We’re probably going to have killed more people than the Vietnam War with this addiction.
Steven B.: Opioids?
Dr. Padda: Opioids. We’re going to have killed more people than the Vietnam War with opioids. And you remember I said food is addictive. We’re going to kill 10, 100 times that in diabetes and excess of carbohydrate consumption, which is also an addiction. It’s just you can have a little remorse and it’s not going to kill you today. The fentanyl will kill you in five minutes. That cookie will take a couple of years.
Steven B.: Dr Padda, sugar is in everything we eat, bread, cheese.
Dr. Padda: Well that’s part of it. So there’s three things that I always tell my patients because the food companies have engineered this stuff. They’ve got this down to a science. They know exactly how to do this. And I’ll give you a wonderful example. They came up with these Fire Doritos and I don’t know if you’ve ever seen this.
Steven B.: Yes. I’ve eaten them.
Dr. Padda: So Fire Doritos are very interesting. Your brain has to be constantly modulated. If I give you one substance and I just give you a steady state of it, it’s not as addictive as if I give you a substance, give you more, then give you less and give you nothing and then give you more and then give you too much.
Dr. Padda: And so it’s the cycle of up and down. So if you look at these Doritos and you look at this food that we’ve got, what happens is the different Doritos have a different hot point. They have a different amount of spice and specifically engineered to tantalize your taste buds so you don’t know what to expect on the next Dorito. And your brain suddenly gets a burst of dopamine. And then it gets less and then it gets a burst of dopamine. It’s like kind of hitting the jackpot in the casino. Three out of a hundred times you’re going to hit the jackpot. The other 97 you’re probably not going to get anywhere. And so every once in a while you’re going to hit the jackpot and you’re going to hear all of everybody else hitting the jackpot, which makes you participate in the casino.
Steven B.: Doctor, where is your office located?
Dr. Padda: So we have a about 10 clinic locations, 11 clinic locations. I’m mostly at the south city office on Chippewa. We have a location in Bridgeton, which is very accessible. It’s right next to DePaul Hospital. We have a location in South County and I prefer being in the city. I’m a city mouse, so I prefer hanging out in the city and dealing with the issues that are of this nature.
Steven B.: Right, right. Of course. Dr. I mean, you’re at LaClede Town [crosstalk 00:03:02] back in the day.
Dr. Padda: I grew up in LaClede Town.
Steven B.: You’ve connected with the people downtown and you’re probably still connecting with friends for over years and their families.
Dr. Padda: Yeah, we’re trying to connect as deeply as possible. There are a variety of projects that we try to connect into and try to assist in the community. My biggest thing right now is yes, we know that addiction to opiates will kill 60,000 but addiction to sugar and our fast food industry, and our processed food industry-
Steven B.: It could happen to more.
Dr. Padda: Well, it’ll be millions. The opioid epidemic, it’ll be 20, 30, 40, 50, 100 billion. But this epidemic of diabetes and metabolic syndrome from the food that we eat, we’re talking two or three trillion.
Dr. Padda: And so my goal is to assist in fixing the bigger problem. And that is the consumption of the food that we shouldn’t be having. We can fix type two diabetes. We can fix it in one generation. We can fix it in three months. We can fix this entire issue. So why do we continue to ignore the biggest healthcare crisis that we have?
Steven B.: Dr Padda cigarettes is subsidized by the government. How come we just can’t take those off the shelves?
Dr. Padda: It’s money. These industries are heavily subsidized. They have really good lobbyists. And they continue to make money. So the people want the substance because it makes them feel better. It’s the opiate for the masses. And we give them what they want, and of course they’re going to demand more of it, but that doesn’t mean it’s necessarily healthy.
Dr. Padda: And I understand that. I totally respect that. I own restaurants too, and I understand what it is to, to serve food and they’re trying to make money and we all get it. But at the same time, we as individuals have to make decisions that are best for our individual health.
Steven B.: People are making money and they’re killing their own people.
Dr. Padda: Exactly.
Steven B.: Dr Gurpreet Padda. Thank you so very much for coming in on the show this morning.
Dr. Padda: Thank you. I appreciate it.
Steven B.: We got to do this again.
Dr. Padda: Thank you, sir.
Steven B.: Thank you. This is Bethalto Today. We’ll be right back after this.